fs28.formsite.com
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44.214.46.240
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Submitted URL: http://sx.informz.net/z/cjUucD9taT0xMTIzODI2NSZwPTEmdT0xMTgzOTAyMjUwJmxpPTEwNDQ1NDUyMw/index.html
Effective URL: https://fs28.formsite.com/IWbCo3/form11/fill?id96=long-mal
Submission: On September 19 via manual from DE — Scanned from DE
Effective URL: https://fs28.formsite.com/IWbCo3/form11/fill?id96=long-mal
Submission: On September 19 via manual from DE — Scanned from DE
Form analysis 1 forms found in the DOM
POST https://fs28.formsite.com/res/submit
<form method="post" id="FSForm" action="https://fs28.formsite.com/res/submit" enctype="application/x-www-form-urlencoded" onsubmit="return Vromansys.Form.processSubmit(this);">
<div style="display:none">
<input type="hidden" name="GenId" value="dybiaJM3cc9AFtEx">
<input type="hidden" name="LocId" value="IWbCo3/form11">
<input type="hidden" name="EParam" value="AT1kKIiyxDyVnKgV5Ka4B6eLTfEDMMCuFA9mI_bo_cv_4RLdvA2Ffps2REZMuuu7vZP9dpQKLgC9Q4edV-QvqBc6VAmcJw56">
<input type="hidden" name="ElapsedTime" id="ElapsedTime" value="0">
<input type="hidden" name="Referrer" id="Referrer" value="">
<input type="text" name="subject_line" id="subject_line" autocomplete="off"><label for="subject_line">subject_line</label>
</div>
<!-- BEGIN_ITEMS -->
<div class="form_table">
<div class="clear"></div>
<div id="q107" class="q full_width">
<a class="item_anchor" name="ItemAnchor0"></a>
<!-- Google Tag Manager (noscript) -->
<noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-TMLTHGZ" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript>
<!-- End Google Tag Manager (noscript) -->
</div>
<div class="clear"></div>
<div id="q9" class="q full_width">
<a class="item_anchor" name="ItemAnchor1"></a>
<div style="text-align:center"><img src="images/Blue_and_Gold_SX_logo_WithkeyRGB(cropped).jpg" alt="" width="500"></div>
</div>
<div class="clear"></div>
<div id="q10" class="q full_width">
<a class="item_anchor" name="ItemAnchor2"></a>
<div class="segment_header" style="background:#0C2D83;width:auto;text-align:Center;">
<h1 style="font-size:24px;font-family:'Sanchez',serif;padding-bottom:20px;padding-top:20px;">Nomination Acceptance Form </h1>
</div>
</div>
<div class="clear"></div>
<div id="q96" style="display:none" class="q">
<a class="item_anchor" name="ItemAnchor3"></a>
<input type="hidden" name="RESULT_TextField-3" class="text_field" id="RESULT_TextField-3" size="25" value="long-mal">
</div>
<div class="clear"></div>
<div id="q118" style="display:none" class="q">
<a class="item_anchor" name="ItemAnchor4"></a>
<input type="hidden" name="RESULT_TextField-4" class="text_field" id="RESULT_TextField-4" size="25" value="Payment-Received">
</div>
<div class="clear"></div>
<div id="q17" class="q required">
<a class="item_anchor" name="ItemAnchor5"></a>
<span class="question top_question"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Please choose one. Membership grade is listed in your nomination email.</span> <b class="icon_required" style="color:#F00">*</b></span>
<table class="inline_grid choices">
<tbody>
<tr>
<td><input type="radio" name="RESULT_RadioButton-5" class="multiple_choice" id="RESULT_RadioButton-5_0" value="Radio-0"><label for="RESULT_RadioButton-5_0"><span style="font-size:16px;">Yes, I accept the nomination to
<b>Full Membership</b> in Sigma Xi.</span></label></td>
</tr>
<tr>
<td><input type="radio" name="RESULT_RadioButton-5" class="multiple_choice" id="RESULT_RadioButton-5_1" value="Radio-1"><label for="RESULT_RadioButton-5_1"><span style="font-size:16px;">Yes, I accept the nomination to
<b>Associate Membership</b> in Sigma Xi.</span></label></td>
</tr>
</tbody>
</table>
</div>
<div class="clear"></div>
<div id="q18" class="q required">
<a class="item_anchor" name="ItemAnchor6"></a>
<span class="question top_question"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Are you currently a degree seeking student?</span> <b class="icon_required" style="color:#F00">*</b></span>
<table class="inline_grid choices">
<tbody>
<tr>
<td><input type="radio" name="RESULT_RadioButton-6" class="multiple_choice" id="RESULT_RadioButton-6_0" value="Radio-0"><label for="RESULT_RadioButton-6_0"><span style="font-size:16px;">Yes</span></label></td>
</tr>
<tr>
<td><input type="radio" name="RESULT_RadioButton-6" class="multiple_choice" id="RESULT_RadioButton-6_1" value="Radio-1"><label for="RESULT_RadioButton-6_1"><span style="font-size:16px;">No</span></label></td>
</tr>
</tbody>
</table>
</div>
<div class="clear"></div>
<div id="q20" class="q required">
<a class="item_anchor" name="ItemAnchor7"></a>
<label class="question top_question" for="RESULT_RadioButton-7"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Prefix:</span> <b class="icon_required" style="color:#F00">*</b></label>
<select id="RESULT_RadioButton-7" name="RESULT_RadioButton-7" class="drop_down">
<option></option>
<option value="Radio-0">Dr.</option>
<option value="Radio-1">Mr.</option>
<option value="Radio-2">Ms.</option>
<option value="Radio-3">Mrs.</option>
<option value="Radio-4">Mx.</option>
</select>
</div>
<div id="q1" class="q required">
<a class="item_anchor" name="ItemAnchor8"></a>
<label class="question top_question" for="RESULT_TextField-8"><span style="font-size: 16px;"><span style="font-family: Tahoma, sans-serif;">First Name</span><span
style="font-family: Tahoma, sans-serif;">:</span></span> <b class="icon_required" style="color:#F00">*</b></label>
<input type="text" name="RESULT_TextField-8" class="text_field" id="RESULT_TextField-8" size="25" maxlength="255" value="">
</div>
<div id="q19" class="q">
<a class="item_anchor" name="ItemAnchor9"></a>
<label class="question top_question" for="RESULT_TextField-9"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">M.I.</span></label>
<input type="text" name="RESULT_TextField-9" class="text_field" id="RESULT_TextField-9" size="6" maxlength="255" value="">
</div>
<div class="clear"></div>
<div id="q2" class="q required">
<a class="item_anchor" name="ItemAnchor10"></a>
<label class="question top_question" for="RESULT_TextField-10"><span style="font-size: 16px;"><span style="font-family: Tahoma, sans-serif;">Last Name</span><span
style="font-family: Tahoma, sans-serif;">:</span></span> <b class="icon_required" style="color:#F00">*</b></label>
<input type="text" name="RESULT_TextField-10" class="text_field" id="RESULT_TextField-10" size="25" maxlength="255" value="">
</div>
<div id="q21" class="q">
<a class="item_anchor" name="ItemAnchor11"></a>
<label class="question top_question" for="RESULT_TextField-11"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Suffix:</span></label>
<input type="text" name="RESULT_TextField-11" class="text_field" id="RESULT_TextField-11" size="6" maxlength="255" value="">
</div>
<div class="clear"></div>
<div id="q22" class="q required">
<a class="item_anchor" name="ItemAnchor12"></a>
<label class="question top_question" for="RESULT_TextField-12"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Preferred Phone #:</span> <b class="icon_required" style="color:#F00">*</b></label>
<input type="text" name="RESULT_TextField-12" class="text_field" id="RESULT_TextField-12" size="20" maxlength="255" value="">
</div>
<div id="q3" class="q required">
<a class="item_anchor" name="ItemAnchor13"></a>
<label class="question top_question" for="RESULT_TextField-13"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Preferred Email:</span> <b class="icon_required" style="color:#F00">*</b></label>
<input type="email" name="RESULT_TextField-13" class="text_field" id="RESULT_TextField-13" size="25" maxlength="255" value="">
</div>
<div id="q23" class="q">
<a class="item_anchor" name="ItemAnchor14"></a>
<label class="question top_question" for="RESULT_TextField-14"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Alternate Email:</span></label>
<input type="email" name="RESULT_TextField-14" class="text_field" id="RESULT_TextField-14" size="25" maxlength="255" value="">
</div>
<div class="clear"></div>
<div id="q24" class="q required">
<a class="item_anchor" name="ItemAnchor15"></a>
<label class="question top_question" for="RESULT_TextField-15"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Date of Birth (mm/dd/yyyy):</span> <b class="icon_required" style="color:#F00">*</b></label>
<input type="text" name="RESULT_TextField-15" class="text_field" id="RESULT_TextField-15" size="20" maxlength="255" value="">
</div>
<div class="clear"></div>
<div id="q54" class="q full_width">
<a class="item_anchor" name="ItemAnchor16"></a>
<div class="segment_header" style="width:auto;text-align:Left;">
<h1 style="font-size:20px;font-family:'Sanchez',serif;padding-bottom:10px;padding-top:10px;"><span style="font-size:20px;">Mailing Address<span><br>
<span style="font-size:16px;">(This is where your membership certificate will be mailed.)</span></span></span></h1>
</div>
</div>
<div class="clear"></div>
<div id="q63" class="q required">
<a class="item_anchor" name="ItemAnchor18"></a>
<label class="question top_question" for="RESULT_RadioButton-18"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Country:</span> <b class="icon_required" style="color:#F00">*</b></label>
<select id="RESULT_RadioButton-18" name="RESULT_RadioButton-18" class="drop_down">
<option></option>
<option value="Radio-0">United States</option>
<option value="Radio-1">Afghanistan</option>
<option value="Radio-2">Albania</option>
<option value="Radio-3">Algeria</option>
<option value="Radio-4">American Samoa</option>
<option value="Radio-5">Andorra</option>
<option value="Radio-6">Angola</option>
<option value="Radio-7">Anguilla</option>
<option value="Radio-8">Antigua and Barbuda</option>
<option value="Radio-9">Antilles</option>
<option value="Radio-10">Argentina</option>
<option value="Radio-11">Armenia</option>
<option value="Radio-12">Aruba</option>
<option value="Radio-13">Australia</option>
<option value="Radio-14">Austria</option>
<option value="Radio-15">Azerbaijan</option>
<option value="Radio-16">Bahamas</option>
<option value="Radio-17">Bahrain</option>
<option value="Radio-18">Bangladesh</option>
<option value="Radio-19">Barbados</option>
<option value="Radio-20">Belarus</option>
<option value="Radio-21">Belgium</option>
<option value="Radio-22">Belize</option>
<option value="Radio-23">Benin</option>
<option value="Radio-24">Bermuda</option>
<option value="Radio-25">Bhutan</option>
<option value="Radio-26">Bolivia</option>
<option value="Radio-27">Bosnia and Herzegovina</option>
<option value="Radio-28">Botswana</option>
<option value="Radio-29">Brazil</option>
<option value="Radio-30">British Virgin Islands</option>
<option value="Radio-31">Brunei Darussalam</option>
<option value="Radio-32">Bulgaria</option>
<option value="Radio-33">Burkina Faso</option>
<option value="Radio-34">Burkina Faso</option>
<option value="Radio-35">Burma</option>
<option value="Radio-36">Burundi</option>
<option value="Radio-37">Cambodia</option>
<option value="Radio-38">Cameroon</option>
<option value="Radio-39">Canada</option>
<option value="Radio-40">Cape Verde</option>
<option value="Radio-41">Cayman Islands</option>
<option value="Radio-42">Central African Republic</option>
<option value="Radio-43">Chad</option>
<option value="Radio-44">Chile</option>
<option value="Radio-45">China</option>
<option value="Radio-46">Colombia</option>
<option value="Radio-47">Comoros</option>
<option value="Radio-48">Congo</option>
<option value="Radio-49">Cook Islands</option>
<option value="Radio-50">Costa Rica</option>
<option value="Radio-51">Cote D'Ivoire</option>
<option value="Radio-52">Croatia</option>
<option value="Radio-53">Cuba</option>
<option value="Radio-54">Cyprus</option>
<option value="Radio-55">Czech Republic</option>
<option value="Radio-56">Democratic People's Republic of Korea</option>
<option value="Radio-57">Denmark</option>
<option value="Radio-58">Djibouti</option>
<option value="Radio-59">Dominica</option>
<option value="Radio-60">Dominican Republic</option>
<option value="Radio-61">Ecuador</option>
<option value="Radio-62">Egypt</option>
<option value="Radio-63">El Salvador</option>
<option value="Radio-64">Equatorial Guinea</option>
<option value="Radio-65">Eritrea</option>
<option value="Radio-66">Estonia</option>
<option value="Radio-67">Ethiopia</option>
<option value="Radio-68">Faroe Islands</option>
<option value="Radio-69">Fiji</option>
<option value="Radio-70">Finland</option>
<option value="Radio-71">France</option>
<option value="Radio-72">French Guiana</option>
<option value="Radio-73">French Polynesia</option>
<option value="Radio-74">Gabon</option>
<option value="Radio-75">Gambia</option>
<option value="Radio-76">Georgia</option>
<option value="Radio-77">Germany</option>
<option value="Radio-78">Ghana</option>
<option value="Radio-79">Gibraltar</option>
<option value="Radio-80">Greece</option>
<option value="Radio-81">Greenland</option>
<option value="Radio-82">Grenada</option>
<option value="Radio-83">Guadeloupe</option>
<option value="Radio-84">Guam</option>
<option value="Radio-85">Guatemala</option>
<option value="Radio-86">Guernsey</option>
<option value="Radio-87">Guinea</option>
<option value="Radio-88">Guinea-Bissau</option>
<option value="Radio-89">Guyana</option>
<option value="Radio-90">Haiti</option>
<option value="Radio-91">Honduras</option>
<option value="Radio-92">Hong Kong</option>
<option value="Radio-93">Hungary</option>
<option value="Radio-94">Iceland</option>
<option value="Radio-95">India</option>
<option value="Radio-96">Indonesia</option>
<option value="Radio-97">Iran (Islamic Republic of)</option>
<option value="Radio-98">Iraq</option>
<option value="Radio-99">Ireland</option>
<option value="Radio-100">Isle of Man</option>
<option value="Radio-101">Israel</option>
<option value="Radio-102">Italy</option>
<option value="Radio-103">Jamaica</option>
<option value="Radio-104">Japan</option>
<option value="Radio-105">Jersey</option>
<option value="Radio-106">Jordan</option>
<option value="Radio-107">Kazakhstan</option>
<option value="Radio-108">Kenya</option>
<option value="Radio-109">Kiribati</option>
<option value="Radio-110">Kuwait</option>
<option value="Radio-111">Kyrgyzstan</option>
<option value="Radio-112">Lao People's Democratic Republic</option>
<option value="Radio-113">Latvia</option>
<option value="Radio-114">Lebanon</option>
<option value="Radio-115">Lesotho</option>
<option value="Radio-116">Liberia</option>
<option value="Radio-117">Libyan Arab Jamahiriya</option>
<option value="Radio-118">Liechtenstein</option>
<option value="Radio-119">Lithuania</option>
<option value="Radio-120">Luxembourg</option>
<option value="Radio-121">Macao, China</option>
<option value="Radio-122">Macedonia (former Yugoslav Republic of)</option>
<option value="Radio-123">Madagascar</option>
<option value="Radio-124">Malawi</option>
<option value="Radio-125">Malaysia</option>
<option value="Radio-126">Maldives</option>
<option value="Radio-127">Mali</option>
<option value="Radio-128">Malta</option>
<option value="Radio-129">Marshall Islands</option>
<option value="Radio-130">Martinique</option>
<option value="Radio-131">Mauritania</option>
<option value="Radio-132">Mauritius</option>
<option value="Radio-133">Mayotte</option>
<option value="Radio-134">Mexico</option>
<option value="Radio-135">Micronesia</option>
<option value="Radio-136">Moldavia</option>
<option value="Radio-137">Monaco</option>
<option value="Radio-138">Mongolia</option>
<option value="Radio-139">Morocco</option>
<option value="Radio-140">Mozambique</option>
<option value="Radio-141">Myanmar</option>
<option value="Radio-142">Namibia</option>
<option value="Radio-143">Nauru</option>
<option value="Radio-144">Nepal</option>
<option value="Radio-145">Netherlands</option>
<option value="Radio-146">Netherlands Antilles</option>
<option value="Radio-147">New Caledonia</option>
<option value="Radio-148">New Zealand</option>
<option value="Radio-149">Nicaragua</option>
<option value="Radio-150">Niger</option>
<option value="Radio-151">Nigeria</option>
<option value="Radio-152">Northern Mariana Islands</option>
<option value="Radio-153">Norway</option>
<option value="Radio-154">Oman</option>
<option value="Radio-155">Pakistan</option>
<option value="Radio-156">Palau</option>
<option value="Radio-157">Panama</option>
<option value="Radio-158">Papua New Guinea</option>
<option value="Radio-159">Paraguay</option>
<option value="Radio-160">Peru</option>
<option value="Radio-161">Philippines</option>
<option value="Radio-162">Poland</option>
<option value="Radio-163">Portugal</option>
<option value="Radio-164">Qatar</option>
<option value="Radio-165">Republic of Moldova</option>
<option value="Radio-166">Romania</option>
<option value="Radio-167">Russian Federation</option>
<option value="Radio-168">Rwanda</option>
<option value="Radio-169">R騏nion</option>
<option value="Radio-170">Saint Kitts and Nevis</option>
<option value="Radio-171">Saint Lucia</option>
<option value="Radio-172">Samoa</option>
<option value="Radio-173">San Marino</option>
<option value="Radio-174">Sao Tome/Principe</option>
<option value="Radio-175">Saudi Arabia</option>
<option value="Radio-176">Scotland</option>
<option value="Radio-177">Senegal</option>
<option value="Radio-178">Serbia and Montenegro</option>
<option value="Radio-179">Seychelles</option>
<option value="Radio-180">Sierra Leone</option>
<option value="Radio-181">Singapore</option>
<option value="Radio-182">Slovakia</option>
<option value="Radio-183">Slovenia</option>
<option value="Radio-184">Solomon Islands</option>
<option value="Radio-185">Somalia</option>
<option value="Radio-186">South Africa</option>
<option value="Radio-187">South Korea, Republic of</option>
<option value="Radio-188">Spain</option>
<option value="Radio-189">Sri Lanka</option>
<option value="Radio-190">Sudan</option>
<option value="Radio-191">Suriname</option>
<option value="Radio-192">Swaziland</option>
<option value="Radio-193">Sweden</option>
<option value="Radio-194">Switzerland</option>
<option value="Radio-195">Syrian Arab Republic</option>
<option value="Radio-196">Taiwan</option>
<option value="Radio-197">Tajikistan</option>
<option value="Radio-198">Tanzania, United Republic of</option>
<option value="Radio-199">Thailand</option>
<option value="Radio-200">Timor-Leste</option>
<option value="Radio-201">Togo</option>
<option value="Radio-202">Tonga</option>
<option value="Radio-203">Trinidad and Tobago</option>
<option value="Radio-204">Tunisia</option>
<option value="Radio-205">Turkey</option>
<option value="Radio-206">Turkmenistan</option>
<option value="Radio-207">Turks and Caicos Islands</option>
<option value="Radio-208">Tuvalu</option>
<option value="Radio-209">Uganda</option>
<option value="Radio-210">Ukraine</option>
<option value="Radio-211">United Arab Emirates</option>
<option value="Radio-212">United Kingdom</option>
<option value="Radio-213">Uruguay</option>
<option value="Radio-214">Uzbekistan</option>
<option value="Radio-215">Vanuatu</option>
<option value="Radio-216">Venezuela</option>
<option value="Radio-217">Viet Nam</option>
<option value="Radio-218">Wales</option>
<option value="Radio-219">Wallis and Futuna</option>
<option value="Radio-220">Western Sahara</option>
<option value="Radio-221">Yemen</option>
<option value="Radio-222">Zaire</option>
<option value="Radio-223">Zambia</option>
<option value="Radio-224">Zimbabwe</option>
</select>
</div>
<div class="clear"></div>
<div id="q55" class="q required">
<a class="item_anchor" name="ItemAnchor19"></a>
<label class="question top_question" for="RESULT_TextField-19"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Address Line 1:</span> <b class="icon_required" style="color:#F00">*</b></label>
<input type="text" name="RESULT_TextField-19" class="text_field" id="RESULT_TextField-19" size="52" maxlength="255" value="">
</div>
<div class="clear"></div>
<div id="q56" class="q">
<a class="item_anchor" name="ItemAnchor20"></a>
<label class="question top_question" for="RESULT_TextField-20"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Address Line 2:</span></label>
<input type="text" name="RESULT_TextField-20" class="text_field" id="RESULT_TextField-20" size="52" maxlength="255" value="">
</div>
<div class="clear"></div>
<div id="q108" class="q">
<a class="item_anchor" name="ItemAnchor21"></a>
<label class="question top_question" for="RESULT_TextField-21"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Address Line 3:</span></label>
<input type="text" name="RESULT_TextField-21" class="text_field" id="RESULT_TextField-21" size="52" maxlength="255" value="">
</div>
<div class="clear"></div>
<div id="q29" class="q required">
<a class="item_anchor" name="ItemAnchor22"></a>
<label class="question top_question" for="RESULT_TextField-22"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">City:</span> <b class="icon_required" style="color:#F00">*</b></label>
<input type="text" name="RESULT_TextField-22" class="text_field" id="RESULT_TextField-22" size="30" maxlength="255" value="">
</div>
<div id="q64" class="q">
<a class="item_anchor" name="ItemAnchor23"></a>
<label class="question top_question" for="RESULT_TextField-23"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">State:</span></label>
<input type="text" name="RESULT_TextField-23" class="text_field" id="RESULT_TextField-23" size="12" maxlength="255" value="">
</div>
<div class="clear"></div>
<div id="q30" class="q required display_hidden">
<a class="item_anchor" name="ItemAnchor24"></a>
<label class="question top_question" for="RESULT_RadioButton-24"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">State:</span> <b class="icon_required" style="color:#F00">*</b></label>
<select id="RESULT_RadioButton-24" name="RESULT_RadioButton-24" class="drop_down" disabled="">
<option></option>
<option value="Radio-0">Alabama (AL)</option>
<option value="Radio-1">Alaska (AK)</option>
<option value="Radio-2">Arizona (AZ)</option>
<option value="Radio-3">Arkansas (AR)</option>
<option value="Radio-4">California (CA)</option>
<option value="Radio-5">Colorado (CO)</option>
<option value="Radio-6">Connecticut (CT)</option>
<option value="Radio-7">Delaware (DE)</option>
<option value="Radio-8">DC</option>
<option value="Radio-9">Florida (FL)</option>
<option value="Radio-10">Georgia (GA)</option>
<option value="Radio-11">Hawaii (HI)</option>
<option value="Radio-12">Idaho (ID)</option>
<option value="Radio-13">Illinois (IL)</option>
<option value="Radio-14">Indiana (IN)</option>
<option value="Radio-15">Iowa (IA)</option>
<option value="Radio-16">Kansas (KS)</option>
<option value="Radio-17">Kentucky (KY)</option>
<option value="Radio-18">Louisiana (LA)</option>
<option value="Radio-19">Maine (ME)</option>
<option value="Radio-20">Maryland (MD)</option>
<option value="Radio-21">Massachusetts (MA)</option>
<option value="Radio-22">Michigan (MI)</option>
<option value="Radio-23">Minnesota (MN)</option>
<option value="Radio-24">Mississippi (MS)</option>
<option value="Radio-25">Missouri (MO)</option>
<option value="Radio-26">Montana (MT)</option>
<option value="Radio-27">Nebraska (NE)</option>
<option value="Radio-28">Nevada (NV)</option>
<option value="Radio-29">New Hampshire (NH)</option>
<option value="Radio-30">New Jersey (NJ)</option>
<option value="Radio-31">New Mexico (NM)</option>
<option value="Radio-32">New York (NY)</option>
<option value="Radio-33">North Carolina (NC)</option>
<option value="Radio-34">North Dakota (ND)</option>
<option value="Radio-35">Ohio (OH)</option>
<option value="Radio-36">Oklahoma (OK)</option>
<option value="Radio-37">Oregon (OR)</option>
<option value="Radio-38">Pennsylvania (PA)</option>
<option value="Radio-39">Puerto Rico (PR)</option>
<option value="Radio-40">Rhode Island (RI)</option>
<option value="Radio-41">South Carolina (SC)</option>
<option value="Radio-42">South Dakota (SD)</option>
<option value="Radio-43">Tennessee (TN)</option>
<option value="Radio-44">Texas (TX)</option>
<option value="Radio-45">Utah (UT)</option>
<option value="Radio-46">Vermont (VT)</option>
<option value="Radio-47">Virginia (VA)</option>
<option value="Radio-48">Washington (WA)</option>
<option value="Radio-49">West Virginia (WV)</option>
<option value="Radio-50">Wisconsin (WI)</option>
<option value="Radio-51">Wyoming (WY)</option>
</select>
</div>
<div id="q69" class="q required display_hidden">
<a class="item_anchor" name="ItemAnchor25"></a>
<label class="question top_question" for="RESULT_RadioButton-25"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Province:</span> <b class="icon_required" style="color:#F00">*</b></label>
<select id="RESULT_RadioButton-25" name="RESULT_RadioButton-25" class="drop_down" disabled="">
<option></option>
<option value="Radio-0">AB</option>
<option value="Radio-1">BC</option>
<option value="Radio-2">MB</option>
<option value="Radio-3">NB</option>
<option value="Radio-4">NL</option>
<option value="Radio-5">NS</option>
<option value="Radio-6">ON</option>
<option value="Radio-7">PE</option>
<option value="Radio-8">QC</option>
<option value="Radio-9">SK</option>
</select>
</div>
<div id="q31" class="q required">
<a class="item_anchor" name="ItemAnchor26"></a>
<label class="question top_question" for="RESULT_TextField-26"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Postal/Zip Code:</span> <b class="icon_required" style="color:#F00">*</b></label>
<input type="text" name="RESULT_TextField-26" class="text_field" id="RESULT_TextField-26" size="10" maxlength="255" value="">
</div>
<div class="clear"></div>
<div id="q116" class="q required">
<a class="item_anchor" name="ItemAnchor39"></a>
<span class="question top_question"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">American Scientist Magazine Format:</span> <b class="icon_required" style="color:#F00">*</b></span>
<table class="inline_grid choices">
<tbody>
<tr>
<td><input type="radio" name="RESULT_RadioButton-39" class="multiple_choice" id="RESULT_RadioButton-39_0" value="Radio-0"><label for="RESULT_RadioButton-39_0"><span style="font-size:16px;">No Magazine</span></label></td>
</tr>
<tr>
<td><input type="radio" name="RESULT_RadioButton-39" class="multiple_choice" id="RESULT_RadioButton-39_1" value="Radio-1"><label for="RESULT_RadioButton-39_1"><span style="font-size:16px;">Print (Included in your
membership)</span></label></td>
</tr>
<tr>
<td><input type="radio" name="RESULT_RadioButton-39" class="multiple_choice" id="RESULT_RadioButton-39_2" value="Radio-2"><label for="RESULT_RadioButton-39_2"><span style="font-size:16px;">Digital (Included in your
membership)</span></label></td>
</tr>
</tbody>
</table>
</div>
<div class="clear"></div>
<div id="q48" class="q">
<a class="item_anchor" name="ItemAnchor40"></a>
<label class="question top_question" for="RESULT_RadioButton-40"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Gender:</span></label>
<select id="RESULT_RadioButton-40" name="RESULT_RadioButton-40" class="drop_down">
<option></option>
<option value="Radio-0">Male</option>
<option value="Radio-1">Female</option>
<option value="Radio-2">Non-Binary</option>
<option value="Radio-3">Other</option>
</select>
</div>
<div id="q47" class="q">
<a class="item_anchor" name="ItemAnchor41"></a>
<label class="question top_question" for="RESULT_RadioButton-41"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Ethnicity:</span></label>
<select id="RESULT_RadioButton-41" name="RESULT_RadioButton-41" class="drop_down">
<option></option>
<option value="Radio-0">American Indian</option>
<option value="Radio-1">Asian</option>
<option value="Radio-2">Black/African American</option>
<option value="Radio-3">Caucasian</option>
<option value="Radio-4">Hispanic</option>
<option value="Radio-5">Multi-ethnic</option>
<option value="Radio-6">Pacific Islander</option>
<option value="Radio-7">Other</option>
</select>
</div>
<div class="clear"></div>
<div id="q4" class="q required">
<a class="item_anchor" name="ItemAnchor42"></a>
<label class="question top_question" for="RESULT_RadioButton-42"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Primary Field of Study:</span> <b class="icon_required" style="color:#F00">*</b></label>
<select id="RESULT_RadioButton-42" name="RESULT_RadioButton-42" class="drop_down">
<option></option>
<option value="Radio-0">AG - 109 Ecology</option>
<option value="Radio-1">AG - 201 Agriculture</option>
<option value="Radio-2">AG - 202 Agronomy</option>
<option value="Radio-3">AG - 203 Animal Husbandry/Animal Science</option>
<option value="Radio-4">AG - 204 Dairy Science</option>
<option value="Radio-5">AG - 205 Environmental Studies</option>
<option value="Radio-6">AG - 206 Food Science</option>
<option value="Radio-7">AG - 207 Forestry</option>
<option value="Radio-8">AG - 208 Horticulture</option>
<option value="Radio-9">AG - 210 Soils</option>
<option value="Radio-10">AG - 211 Veterinary Medicine</option>
<option value="Radio-11">AG - 212 Poultry Science</option>
<option value="Radio-12">AG - 213 Hydrology</option>
<option value="Radio-13">AG - 250 Other AG</option>
<option value="Radio-14">BIO - 101 Anatomy</option>
<option value="Radio-15">BIO - 102 Bacteriology</option>
<option value="Radio-16">BIO - 103 Biochemistry</option>
<option value="Radio-17">BIO - 104 Biology, General</option>
<option value="Radio-18">BIO - 105 Biometrics/Biostatistics</option>
<option value="Radio-19">BIO - 106 Biophysics</option>
<option value="Radio-20">BIO - 107 Botany</option>
<option value="Radio-21">BIO - 108 Cell Biology/Cytology</option>
<option value="Radio-22">BIO - 109 Ecology</option>
<option value="Radio-23">BIO - 110 Developmental Biology/Embryology</option>
<option value="Radio-24">BIO - 111 Entomology</option>
<option value="Radio-25">BIO - 112 Genetics</option>
<option value="Radio-26">BIO - 113 Histology</option>
<option value="Radio-27">BIO - 114 Marine Biology</option>
<option value="Radio-28">BIO - 115 Microbiology</option>
<option value="Radio-29">BIO - 116 Molecular Biology</option>
<option value="Radio-30">BIO - 117 Neurosciences</option>
<option value="Radio-31">BIO - 118 Ornithology</option>
<option value="Radio-32">BIO - 119 Parasitology</option>
<option value="Radio-33">BIO - 120 Pathology</option>
<option value="Radio-34">BIO - 121 Physiology</option>
<option value="Radio-35">BIO - 122 Plant Pathology</option>
<option value="Radio-36">BIO - 123 Plant Physiology</option>
<option value="Radio-37">BIO - 124 Radiobiology</option>
<option value="Radio-38">BIO - 125 Toxicology</option>
<option value="Radio-39">BIO - 126 Zoology</option>
<option value="Radio-40">BIO - 128 Systematic Biology/Evolution</option>
<option value="Radio-41">BIO - 129 Biotechnology</option>
<option value="Radio-42">BIO - 130 Plant Breeding/Genetics</option>
<option value="Radio-43">BIO - 150 Other Biological Sciences</option>
<option value="Radio-44">ENGR - 301 Aerospace, Aero- & Astronautical Engineering</option>
<option value="Radio-45">ENGR - 302 Agricultural Engineering</option>
<option value="Radio-46">ENGR - 303 Architectural Engineering</option>
<option value="Radio-47">ENGR - 304 Bioengineering & Biomedical Engineering</option>
<option value="Radio-48">ENGR - 305 Ceramic Engineering</option>
<option value="Radio-49">ENGR - 306 Chemical Engineering</option>
<option value="Radio-50">ENGR - 307 Civil, Construction, & Transportation Engineering</option>
<option value="Radio-51">ENGR - 308 Electrical, Electronics & Comm. Engineering</option>
<option value="Radio-52">ENGR - 309 Engineering, General</option>
<option value="Radio-53">ENGR - 310 Environmental & Sanitary Engineering</option>
<option value="Radio-54">ENGR - 311 Industrial Engineering</option>
<option value="Radio-55">ENGR - 312 Materials Science</option>
<option value="Radio-56">ENGR - 313 Mechanical Engineering</option>
<option value="Radio-57">ENGR - 314 Metallurgy</option>
<option value="Radio-58">ENGR - 315 Mining & Mineral Engineering</option>
<option value="Radio-59">ENGR - 316 Naval Architecture & Marine Engineering</option>
<option value="Radio-60">ENGR - 317 Nuclear Engineering</option>
<option value="Radio-61">ENGR - 319 Textile Engineering</option>
<option value="Radio-62">ENGR - 320 Petroleum Engineering</option>
<option value="Radio-63">ENGR - 321 Quality Engineering</option>
<option value="Radio-64">ENGR - 322 Metallurgical Engineering</option>
<option value="Radio-65">ENGR - 323 Nondestructive Testing</option>
<option value="Radio-66">ENGR - 350 Other Engineering Sciences</option>
<option value="Radio-67">HEALTH - 105 Biometrics/Biostatistics</option>
<option value="Radio-68">HEALTH - 112 Genetics</option>
<option value="Radio-69">HEALTH - 120 Pathology</option>
<option value="Radio-70">HEALTH - 121 Physiology</option>
<option value="Radio-71">HEALTH - 125 Toxicology</option>
<option value="Radio-72">HEALTH - 211 Veterinary Medicine</option>
<option value="Radio-73">HEALTH - 401 Dentistry</option>
<option value="Radio-74">HEALTH - 402 Dermatology</option>
<option value="Radio-75">HEALTH - 403 Endocrinology</option>
<option value="Radio-76">HEALTH - 404 Health Professions, General</option>
<option value="Radio-77">HEALTH - 405 Hospital & Health Care Administration</option>
<option value="Radio-78">HEALTH - 406 Medical Laboratory Technology</option>
<option value="Radio-79">HEALTH - 407 Medical Record Librarianship</option>
<option value="Radio-80">HEALTH - 408 Medicine</option>
<option value="Radio-81">HEALTH - 409 Nursing</option>
<option value="Radio-82">HEALTH - 410 Occupational Therapy</option>
<option value="Radio-83">HEALTH - 411 Ophthalmology</option>
<option value="Radio-84">HEALTH - 412 Pediatrics</option>
<option value="Radio-85">HEALTH - 413 Physical Therapy</option>
<option value="Radio-86">HEALTH - 414 Psychiatry</option>
<option value="Radio-87">HEALTH - 415 Public Health/Epidemiology</option>
<option value="Radio-88">HEALTH - 416 Podiatry</option>
<option value="Radio-89">HEALTH - 417 Radiology</option>
<option value="Radio-90">HEALTH - 418 Speech Pathology & Audiology</option>
<option value="Radio-91">HEALTH - 419 Surgery</option>
<option value="Radio-92">HEALTH - 420 Obstetrics/Gynecology</option>
<option value="Radio-93">HEALTH - 421 Immunology</option>
<option value="Radio-94">HEALTH - 422 Nutrition</option>
<option value="Radio-95">HEALTH - 423 Otolaryngology</option>
<option value="Radio-96">HEALTH - 424 Forensic Science</option>
<option value="Radio-97">HEALTH - 425 Medicinal Chemistry</option>
<option value="Radio-98">HEALTH - 450 Other Health Sciences</option>
<option value="Radio-99">HEALTH - 615 Pharmacology/Pharmacy</option>
<option value="Radio-100">MA/CS - 308 Electrical, Electronics, & Comm Engineering</option>
<option value="Radio-101">MA/CS - 501 Applied Mathematics</option>
<option value="Radio-102">MA/CS - 502 Artificial Intelligence</option>
<option value="Radio-103">MA/CS - 503 Computer Science, General</option>
<option value="Radio-104">MA/CS - 504 Mathematics, General</option>
<option value="Radio-105">MA/CS - 505 Statistics</option>
<option value="Radio-106">MA/CS - 506 Systems Analysis</option>
<option value="Radio-107">MA/CS - 507 Number Theory & Combinatorics</option>
<option value="Radio-108">MA/CS - 508 Algebra & Geometry</option>
<option value="Radio-109">MA/CS - 509 Differential Equations & Functional Analysis</option>
<option value="Radio-110">MA/CS - 510 Topology</option>
<option value="Radio-111">MA/CS - 511 Numerical Analysis</option>
<option value="Radio-112">MA/CS - 550 Other Math & Computer Sciences</option>
<option value="Radio-113">PHYS - 213 Hydrology</option>
<option value="Radio-114">PHYS - 312 Materials Science</option>
<option value="Radio-115">PHYS - 601 Astronomy</option>
<option value="Radio-116">PHYS - 602 Astrophysics</option>
<option value="Radio-117">PHYS - 603 Atmospheric Sciences & Meteorology</option>
<option value="Radio-118">PHYS - 604 Chemistry</option>
<option value="Radio-119">PHYS - 605 Geochemistry</option>
<option value="Radio-120">PHYS - 606 Geology</option>
<option value="Radio-121">PHYS - 607 Geophysics</option>
<option value="Radio-122">PHYS - 608 Inorganic Chemistry</option>
<option value="Radio-123">PHYS - 609 Mineralogy</option>
<option value="Radio-124">PHYS - 610 Molecular Physics</option>
<option value="Radio-125">PHYS - 611 Nuclear Physics</option>
<option value="Radio-126">PHYS - 612 Oceanography</option>
<option value="Radio-127">PHYS - 613 Organic Chemistry</option>
<option value="Radio-128">PHYS - 614 Paleontology</option>
<option value="Radio-129">PHYS - 615 Pharmacology/Pharmacy</option>
<option value="Radio-130">PHYS - 616 Physical Chemistry</option>
<option value="Radio-131">PHYS - 617 Physical Geography</option>
<option value="Radio-132">PHYS - 618 Physics, General (Exclude Biophysics)</option>
<option value="Radio-133">PHYS - 619 Analytical Chemistry</option>
<option value="Radio-134">PHYS - 620 Atomic Physics</option>
<option value="Radio-135">PHYS - 621 Condensed Matter</option>
<option value="Radio-136">PHYS - 622 Elementary Particles</option>
<option value="Radio-137">PHYS - 623 Plasma Physics</option>
<option value="Radio-138">PHYS - 624 Optics & Laser Physics</option>
<option value="Radio-139">PHYS - 625 Crystallography</option>
<option value="Radio-140">PHYS - 626 Polymer Science</option>
<option value="Radio-141">PHYS - 627 Nuclear Chemistry</option>
<option value="Radio-142">PHYS - 628 Particle Physics</option>
<option value="Radio-143">PHYS - 650 Other Physical & Earth Sciences</option>
<option value="Radio-144">SOC - 701 Administration (Organization & Management)</option>
<option value="Radio-145">SOC - 702 Anthropology</option>
<option value="Radio-146">SOC - 703 Archaeology</option>
<option value="Radio-147">SOC - 704 Criminology</option>
<option value="Radio-148">SOC - 705 Demography</option>
<option value="Radio-149">SOC - 706 Economics</option>
<option value="Radio-150">SOC - 707 Geography</option>
<option value="Radio-151">SOC - 708 History</option>
<option value="Radio-152">SOC - 709 International Relations</option>
<option value="Radio-153">SOC - 710 Library Science</option>
<option value="Radio-154">SOC - 711 Linguistics</option>
<option value="Radio-155">SOC - 712 Philosophy</option>
<option value="Radio-156">SOC - 713 Political Science & Government</option>
<option value="Radio-157">SOC - 714 Psychology</option>
<option value="Radio-158">SOC - 715 Sociology</option>
<option value="Radio-159">SOC - 716 Urban Studies</option>
<option value="Radio-160">SOC - 717 Science Policy</option>
<option value="Radio-161">SOC - 718 Cognitive Science</option>
<option value="Radio-162">SOC - 719 Education</option>
<option value="Radio-163">SOC - 720 Science Writing</option>
<option value="Radio-164">SOC - 721 History & Philosophy of Science</option>
<option value="Radio-165">SOC - 750 Other Social Sciences</option>
</select>
</div>
<div class="clear"></div>
<div id="q5" class="q required">
<a class="item_anchor" name="ItemAnchor43"></a>
<label class="question top_question" for="RESULT_RadioButton-43"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Secondary Field of Study:</span> <b class="icon_required" style="color:#F00">*</b></label>
<select id="RESULT_RadioButton-43" name="RESULT_RadioButton-43" class="drop_down">
<option></option>
<option value="Radio-0">AG - 109 Ecology</option>
<option value="Radio-1">AG - 201 Agriculture</option>
<option value="Radio-2">AG - 202 Agronomy</option>
<option value="Radio-3">AG - 203 Animal Husbandry/Animal Science</option>
<option value="Radio-4">AG - 204 Dairy Science</option>
<option value="Radio-5">AG - 205 Environmental Studies</option>
<option value="Radio-6">AG - 206 Food Science</option>
<option value="Radio-7">AG - 207 Forestry</option>
<option value="Radio-8">AG - 208 Horticulture</option>
<option value="Radio-9">AG - 210 Soils</option>
<option value="Radio-10">AG - 211 Veterinary Medicine</option>
<option value="Radio-11">AG - 212 Poultry Science</option>
<option value="Radio-12">AG - 213 Hydrology</option>
<option value="Radio-13">AG - 250 Other AG</option>
<option value="Radio-14">BIO - 101 Anatomy</option>
<option value="Radio-15">BIO - 102 Bacteriology</option>
<option value="Radio-16">BIO - 103 Biochemistry</option>
<option value="Radio-17">BIO - 104 Biology, General</option>
<option value="Radio-18">BIO - 105 Biometrics/Biostatistics</option>
<option value="Radio-19">BIO - 106 Biophysics</option>
<option value="Radio-20">BIO - 107 Botany</option>
<option value="Radio-21">BIO - 108 Cell Biology/Cytology</option>
<option value="Radio-22">BIO - 109 Ecology</option>
<option value="Radio-23">BIO - 110 Developmental Biology/Embryology</option>
<option value="Radio-24">BIO - 111 Entomology</option>
<option value="Radio-25">BIO - 112 Genetics</option>
<option value="Radio-26">BIO - 113 Histology</option>
<option value="Radio-27">BIO - 114 Marine Biology</option>
<option value="Radio-28">BIO - 115 Microbiology</option>
<option value="Radio-29">BIO - 116 Molecular Biology</option>
<option value="Radio-30">BIO - 117 Neurosciences</option>
<option value="Radio-31">BIO - 118 Ornithology</option>
<option value="Radio-32">BIO - 119 Parasitology</option>
<option value="Radio-33">BIO - 120 Pathology</option>
<option value="Radio-34">BIO - 121 Physiology</option>
<option value="Radio-35">BIO - 122 Plant Pathology</option>
<option value="Radio-36">BIO - 123 Plant Physiology</option>
<option value="Radio-37">BIO - 124 Radiobiology</option>
<option value="Radio-38">BIO - 125 Toxicology</option>
<option value="Radio-39">BIO - 126 Zoology</option>
<option value="Radio-40">BIO - 128 Systematic Biology/Evolution</option>
<option value="Radio-41">BIO - 129 Biotechnology</option>
<option value="Radio-42">BIO - 130 Plant Breeding/Genetics</option>
<option value="Radio-43">BIO - 150 Other Biological Sciences</option>
<option value="Radio-44">ENGR - 301 Aerospace, Aero- & Astronautical Engineering</option>
<option value="Radio-45">ENGR - 302 Agricultural Engineering</option>
<option value="Radio-46">ENGR - 303 Architectural Engineering</option>
<option value="Radio-47">ENGR - 304 Bioengineering & Biomedical Engineering</option>
<option value="Radio-48">ENGR - 305 Ceramic Engineering</option>
<option value="Radio-49">ENGR - 306 Chemical Engineering</option>
<option value="Radio-50">ENGR - 307 Civil, Construction, & Transportation Engineering</option>
<option value="Radio-51">ENGR - 308 Electrical, Electronics & Comm. Engineering</option>
<option value="Radio-52">ENGR - 309 Engineering, General</option>
<option value="Radio-53">ENGR - 310 Environmental & Sanitary Engineering</option>
<option value="Radio-54">ENGR - 311 Industrial Engineering</option>
<option value="Radio-55">ENGR - 312 Materials Science</option>
<option value="Radio-56">ENGR - 313 Mechanical Engineering</option>
<option value="Radio-57">ENGR - 314 Metallurgy</option>
<option value="Radio-58">ENGR - 315 Mining & Mineral Engineering</option>
<option value="Radio-59">ENGR - 316 Naval Architecture & Marine Engineering</option>
<option value="Radio-60">ENGR - 317 Nuclear Engineering</option>
<option value="Radio-61">ENGR - 319 Textile Engineering</option>
<option value="Radio-62">ENGR - 320 Petroleum Engineering</option>
<option value="Radio-63">ENGR - 321 Quality Engineering</option>
<option value="Radio-64">ENGR - 322 Metallurgical Engineering</option>
<option value="Radio-65">ENGR - 323 Nondestructive Testing</option>
<option value="Radio-66">ENGR - 350 Other Engineering Sciences</option>
<option value="Radio-67">HEALTH - 105 Biometrics/Biostatistics</option>
<option value="Radio-68">HEALTH - 112 Genetics</option>
<option value="Radio-69">HEALTH - 120 Pathology</option>
<option value="Radio-70">HEALTH - 121 Physiology</option>
<option value="Radio-71">HEALTH - 125 Toxicology</option>
<option value="Radio-72">HEALTH - 211 Veterinary Medicine</option>
<option value="Radio-73">HEALTH - 401 Dentistry</option>
<option value="Radio-74">HEALTH - 402 Dermatology</option>
<option value="Radio-75">HEALTH - 403 Endocrinology</option>
<option value="Radio-76">HEALTH - 404 Health Professions, General</option>
<option value="Radio-77">HEALTH - 405 Hospital & Health Care Administration</option>
<option value="Radio-78">HEALTH - 406 Medical Laboratory Technology</option>
<option value="Radio-79">HEALTH - 407 Medical Record Librarianship</option>
<option value="Radio-80">HEALTH - 408 Medicine</option>
<option value="Radio-81">HEALTH - 409 Nursing</option>
<option value="Radio-82">HEALTH - 410 Occupational Therapy</option>
<option value="Radio-83">HEALTH - 411 Ophthalmology</option>
<option value="Radio-84">HEALTH - 412 Pediatrics</option>
<option value="Radio-85">HEALTH - 413 Physical Therapy</option>
<option value="Radio-86">HEALTH - 414 Psychiatry</option>
<option value="Radio-87">HEALTH - 415 Public Health/Epidemiology</option>
<option value="Radio-88">HEALTH - 416 Podiatry</option>
<option value="Radio-89">HEALTH - 417 Radiology</option>
<option value="Radio-90">HEALTH - 418 Speech Pathology & Audiology</option>
<option value="Radio-91">HEALTH - 419 Surgery</option>
<option value="Radio-92">HEALTH - 420 Obstetrics/Gynecology</option>
<option value="Radio-93">HEALTH - 421 Immunology</option>
<option value="Radio-94">HEALTH - 422 Nutrition</option>
<option value="Radio-95">HEALTH - 423 Otolaryngology</option>
<option value="Radio-96">HEALTH - 424 Forensic Science</option>
<option value="Radio-97">HEALTH - 425 Medicinal Chemistry</option>
<option value="Radio-98">HEALTH - 450 Other Health Sciences</option>
<option value="Radio-99">HEALTH - 615 Pharmacology/Pharmacy</option>
<option value="Radio-100">MA/CS - 308 Electrical, Electronics, & Comm Engineering</option>
<option value="Radio-101">MA/CS - 501 Applied Mathematics</option>
<option value="Radio-102">MA/CS - 502 Artificial Intelligence</option>
<option value="Radio-103">MA/CS - 503 Computer Science, General</option>
<option value="Radio-104">MA/CS - 504 Mathematics, General</option>
<option value="Radio-105">MA/CS - 505 Statistics</option>
<option value="Radio-106">MA/CS - 506 Systems Analysis</option>
<option value="Radio-107">MA/CS - 507 Number Theory & Combinatorics</option>
<option value="Radio-108">MA/CS - 508 Algebra & Geometry</option>
<option value="Radio-109">MA/CS - 509 Differential Equations & Functional Analysis</option>
<option value="Radio-110">MA/CS - 510 Topology</option>
<option value="Radio-111">MA/CS - 511 Numerical Analysis</option>
<option value="Radio-112">MA/CS - 550 Other Math & Computer Sciences</option>
<option value="Radio-113">PHYS - 213 Hydrology</option>
<option value="Radio-114">PHYS - 312 Materials Science</option>
<option value="Radio-115">PHYS - 601 Astronomy</option>
<option value="Radio-116">PHYS - 602 Astrophysics</option>
<option value="Radio-117">PHYS - 603 Atmospheric Sciences & Meteorology</option>
<option value="Radio-118">PHYS - 604 Chemistry</option>
<option value="Radio-119">PHYS - 605 Geochemistry</option>
<option value="Radio-120">PHYS - 606 Geology</option>
<option value="Radio-121">PHYS - 607 Geophysics</option>
<option value="Radio-122">PHYS - 608 Inorganic Chemistry</option>
<option value="Radio-123">PHYS - 609 Mineralogy</option>
<option value="Radio-124">PHYS - 610 Molecular Physics</option>
<option value="Radio-125">PHYS - 611 Nuclear Physics</option>
<option value="Radio-126">PHYS - 612 Oceanography</option>
<option value="Radio-127">PHYS - 613 Organic Chemistry</option>
<option value="Radio-128">PHYS - 614 Paleontology</option>
<option value="Radio-129">PHYS - 615 Pharmacology/Pharmacy</option>
<option value="Radio-130">PHYS - 616 Physical Chemistry</option>
<option value="Radio-131">PHYS - 617 Physical Geography</option>
<option value="Radio-132">PHYS - 618 Physics, General (Exclude Biophysics)</option>
<option value="Radio-133">PHYS - 619 Analytical Chemistry</option>
<option value="Radio-134">PHYS - 620 Atomic Physics</option>
<option value="Radio-135">PHYS - 621 Condensed Matter</option>
<option value="Radio-136">PHYS - 622 Elementary Particles</option>
<option value="Radio-137">PHYS - 623 Plasma Physics</option>
<option value="Radio-138">PHYS - 624 Optics & Laser Physics</option>
<option value="Radio-139">PHYS - 625 Crystallography</option>
<option value="Radio-140">PHYS - 626 Polymer Science</option>
<option value="Radio-141">PHYS - 627 Nuclear Chemistry</option>
<option value="Radio-142">PHYS - 628 Particle Physics</option>
<option value="Radio-143">PHYS - 650 Other Physical & Earth Sciences</option>
<option value="Radio-144">SOC - 701 Administration (Organization & Management)</option>
<option value="Radio-145">SOC - 702 Anthropology</option>
<option value="Radio-146">SOC - 703 Archaeology</option>
<option value="Radio-147">SOC - 704 Criminology</option>
<option value="Radio-148">SOC - 705 Demography</option>
<option value="Radio-149">SOC - 706 Economics</option>
<option value="Radio-150">SOC - 707 Geography</option>
<option value="Radio-151">SOC - 708 History</option>
<option value="Radio-152">SOC - 709 International Relations</option>
<option value="Radio-153">SOC - 710 Library Science</option>
<option value="Radio-154">SOC - 711 Linguistics</option>
<option value="Radio-155">SOC - 712 Philosophy</option>
<option value="Radio-156">SOC - 713 Political Science & Government</option>
<option value="Radio-157">SOC - 714 Psychology</option>
<option value="Radio-158">SOC - 715 Sociology</option>
<option value="Radio-159">SOC - 716 Urban Studies</option>
<option value="Radio-160">SOC - 717 Science Policy</option>
<option value="Radio-161">SOC - 718 Cognitive Science</option>
<option value="Radio-162">SOC - 719 Education</option>
<option value="Radio-163">SOC - 720 Science Writing</option>
<option value="Radio-164">SOC - 721 History & Philosophy of Science</option>
<option value="Radio-165">SOC - 750 Other Social Sciences</option>
</select>
</div>
<div class="clear"></div>
<div id="q49" class="q required display_hidden">
<a class="item_anchor" name="ItemAnchor44"></a>
<label class="question top_question" for="RESULT_TextField-44"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Business or Institution (If retired, enter
'Retired'):</span> <b class="icon_required" style="color:#F00">*</b></label>
<input type="text" name="RESULT_TextField-44" class="text_field" id="RESULT_TextField-44" size="50" maxlength="255" value="" disabled="">
</div>
<div class="clear"></div>
<div id="q57" class="q required display_hidden">
<a class="item_anchor" name="ItemAnchor45"></a>
<label class="question top_question" for="RESULT_TextField-45"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Institution:</span> <b class="icon_required" style="color:#F00">*</b></label>
<input type="text" name="RESULT_TextField-45" class="text_field" id="RESULT_TextField-45" size="50" maxlength="255" value="" disabled="">
</div>
<div class="clear"></div>
<div id="q50" class="q required display_hidden">
<a class="item_anchor" name="ItemAnchor46"></a>
<label class="question top_question" for="RESULT_RadioButton-46"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Position:</span> <b class="icon_required" style="color:#F00">*</b></label>
<select id="RESULT_RadioButton-46" name="RESULT_RadioButton-46" class="drop_down" disabled="">
<option></option>
<option value="Radio-0">Administrator</option>
<option value="Radio-1">Assistant Professor</option>
<option value="Radio-2">Associate Professor</option>
<option value="Radio-3">Editor/Journalist</option>
<option value="Radio-4">Engineer</option>
<option value="Radio-5">Physician</option>
<option value="Radio-6">Postdoc</option>
<option value="Radio-7">Professor</option>
<option value="Radio-8">Research Scientist</option>
<option value="Radio-9">Other</option>
</select>
</div>
<div id="q58" class="q required display_hidden">
<a class="item_anchor" name="ItemAnchor47"></a>
<label class="question top_question" for="RESULT_TextField-47"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Position- Other:</span> <b class="icon_required" style="color:#F00">*</b></label>
<input type="text" name="RESULT_TextField-47" class="text_field" id="RESULT_TextField-47" size="25" maxlength="255" value="" disabled="">
</div>
<div id="q51" class="q required display_hidden">
<a class="item_anchor" name="ItemAnchor48"></a>
<label class="question top_question" for="RESULT_RadioButton-48"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Employment Sector:</span> <b class="icon_required" style="color:#F00">*</b></label>
<select id="RESULT_RadioButton-48" name="RESULT_RadioButton-48" class="drop_down" disabled="">
<option></option>
<option value="Radio-0">Academic</option>
<option value="Radio-1">Government</option>
<option value="Radio-2">Healthcare</option>
<option value="Radio-3">Industry</option>
<option value="Radio-4">Research and Development</option>
<option value="Radio-5">Other</option>
</select>
</div>
<div id="q59" class="q required display_hidden">
<a class="item_anchor" name="ItemAnchor49"></a>
<label class="question top_question" for="RESULT_TextField-49"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Employment Sector- Other:</span> <b class="icon_required" style="color:#F00">*</b></label>
<input type="text" name="RESULT_TextField-49" class="text_field" id="RESULT_TextField-49" size="25" maxlength="255" value="" disabled="">
</div>
<div class="clear"></div>
<div id="q52" class="q required display_hidden">
<a class="item_anchor" name="ItemAnchor50"></a>
<label class="question top_question" for="RESULT_RadioButton-50"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Highest Degree:</span> <b class="icon_required" style="color:#F00">*</b></label>
<select id="RESULT_RadioButton-50" name="RESULT_RadioButton-50" class="drop_down" disabled="">
<option></option>
<option value="Radio-0">BS</option>
<option value="Radio-1">MA</option>
<option value="Radio-2">MS</option>
<option value="Radio-3">PhD</option>
<option value="Radio-4">MD</option>
<option value="Radio-5">MD/PhD</option>
<option value="Radio-6">PharmD</option>
<option value="Radio-7">EdD</option>
<option value="Radio-8">Other</option>
</select>
</div>
<div id="q60" class="q required display_hidden">
<a class="item_anchor" name="ItemAnchor51"></a>
<label class="question top_question" for="RESULT_TextField-51"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Highest Degree- Other:</span> <b class="icon_required" style="color:#F00">*</b></label>
<input type="text" name="RESULT_TextField-51" class="text_field" id="RESULT_TextField-51" size="25" maxlength="255" value="" disabled="">
</div>
<div class="clear"></div>
<div id="q53" class="q required display_hidden">
<a class="item_anchor" name="ItemAnchor52"></a>
<label class="question top_question" for="RESULT_RadioButton-52"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Degree Currently Seeking:</span> <b class="icon_required" style="color:#F00">*</b></label>
<select id="RESULT_RadioButton-52" name="RESULT_RadioButton-52" class="drop_down" disabled="">
<option></option>
<option value="Radio-0">BS</option>
<option value="Radio-1">MA</option>
<option value="Radio-2">MS</option>
<option value="Radio-3">PhD</option>
<option value="Radio-4">MD</option>
<option value="Radio-5">MD/PhD</option>
<option value="Radio-6">PharmD</option>
<option value="Radio-7">EdD</option>
<option value="Radio-8">Other</option>
</select>
</div>
<div id="q61" class="q required display_hidden">
<a class="item_anchor" name="ItemAnchor53"></a>
<label class="question top_question" for="RESULT_TextField-53"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Degree Currently Seeking- Other:</span> <b class="icon_required" style="color:#F00">*</b></label>
<input type="text" name="RESULT_TextField-53" class="text_field" id="RESULT_TextField-53" size="25" maxlength="255" value="" disabled="">
</div>
<div class="clear"></div>
<div id="q6" class="q required">
<a class="item_anchor" name="ItemAnchor54"></a>
<label class="question top_question" for="RESULT_RadioButton-54"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Chapter Affiliation:</span><br><span style="font-size: 16px;"><span style="font-family: Tahoma, sans-serif;">(If
none, please select 'Membership At Large'</span><span style="font-family: Tahoma, sans-serif;">)</span></span> <b class="icon_required" style="color:#F00">*</b></label>
<select id="RESULT_RadioButton-54" name="RESULT_RadioButton-54" class="drop_down">
<option></option>
<option value="Radio-0">Abbott Laboratories</option>
<option value="Radio-1">Air Force Dayton</option>
<option value="Radio-2">Alamo</option>
<option value="Radio-3">Alaska</option>
<option value="Radio-4">Albany</option>
<option value="Radio-5">Albany, New York</option>
<option value="Radio-6">Albion College</option>
<option value="Radio-7">Alcoa</option>
<option value="Radio-8">Alfred University</option>
<option value="Radio-9">American University</option>
<option value="Radio-10">American University of Beirut</option>
<option value="Radio-11">Amherst College</option>
<option value="Radio-12">Andrews-Whirlpool</option>
<option value="Radio-13">Appalachian State University</option>
<option value="Radio-14">Argonne National Laboratory</option>
<option value="Radio-15">Arizona State University</option>
<option value="Radio-16">Arkansas State University</option>
<option value="Radio-17">Army Research Laboratory (ARL)</option>
<option value="Radio-18">Atlanta University Center</option>
<option value="Radio-19">Auburn University</option>
<option value="Radio-20">Austin College</option>
<option value="Radio-21">Australian</option>
<option value="Radio-22">Avalon</option>
<option value="Radio-23">B. P. America</option>
<option value="Radio-24">Ball State University</option>
<option value="Radio-25">Bangkok Thailand</option>
<option value="Radio-26">Barry University</option>
<option value="Radio-27">Baylor College of Dentistry</option>
<option value="Radio-28">Baylor University</option>
<option value="Radio-29">Berry College</option>
<option value="Radio-30">Black Hills Regional</option>
<option value="Radio-31">Boeing North American</option>
<option value="Radio-32">Boise State University</option>
<option value="Radio-33">Boston University</option>
<option value="Radio-34">Bowling Green State University</option>
<option value="Radio-35">Brigham Young University</option>
<option value="Radio-36">Brooklyn College</option>
<option value="Radio-37">Brown University</option>
<option value="Radio-38">Bryn Mawr College</option>
<option value="Radio-39">Bucknell University</option>
<option value="Radio-40">Butler-Indianapolis</option>
<option value="Radio-41">C.W. Post College</option>
<option value="Radio-42">California Institute of Technology</option>
<option value="Radio-43">California Polytechnic State University</option>
<option value="Radio-44">California State Polytechnic University</option>
<option value="Radio-45">California State University-Bakersfield</option>
<option value="Radio-46">California State University-Chico</option>
<option value="Radio-47">California State University-Dominguez Hills</option>
<option value="Radio-48">California State University-Fresno</option>
<option value="Radio-49">California State University-Hayward</option>
<option value="Radio-50">California State University-Long Beach</option>
<option value="Radio-51">California State University-Northridge</option>
<option value="Radio-52">California State University-Sacramento</option>
<option value="Radio-53">California State University-San Bernardino</option>
<option value="Radio-54">Calspan Corporation</option>
<option value="Radio-55">Carleton College</option>
<option value="Radio-56">Carnegie Mellon University</option>
<option value="Radio-57">Carthage College</option>
<option value="Radio-58">Case Western Reserve University</option>
<option value="Radio-59">Catholic University of America</option>
<option value="Radio-60">Center For Naval Analyses</option>
<option value="Radio-61">Centers for Disease Control and Prevention</option>
<option value="Radio-62">Central Arkansas</option>
<option value="Radio-63">Central Michigan</option>
<option value="Radio-64">Central Savannah River Area</option>
<option value="Radio-65">Central Texas Research Society</option>
<option value="Radio-66">Charleston</option>
<option value="Radio-67">Charlotte</option>
<option value="Radio-68">Chesapeake</option>
<option value="Radio-69">China Lake</option>
<option value="Radio-70">Cincinnati Federal Environmental</option>
<option value="Radio-71">CINVESTAV</option>
<option value="Radio-72">City College of the City University of New York</option>
<option value="Radio-73">Claremont Colleges</option>
<option value="Radio-74">Clarkson University</option>
<option value="Radio-75">Clear Lake</option>
<option value="Radio-76">Clemson University</option>
<option value="Radio-77">College of Mount Saint Vincent</option>
<option value="Radio-78">College of The Holy Cross</option>
<option value="Radio-79">College of William And Mary</option>
<option value="Radio-80">Colorado School of Mines</option>
<option value="Radio-81">Colorado State University</option>
<option value="Radio-82">Colorado State University - Pueblo</option>
<option value="Radio-83">Columbia University</option>
<option value="Radio-84">Columbia-Willamette</option>
<option value="Radio-85">Cornell University</option>
<option value="Radio-86">Corning Incorporated</option>
<option value="Radio-87">D O E/N R C</option>
<option value="Radio-88">Dartmouth College</option>
<option value="Radio-89">David W. Taylor</option>
<option value="Radio-90">Delta</option>
<option value="Radio-91">Denison University</option>
<option value="Radio-92">Depauw-Wabash</option>
<option value="Radio-93">Development Contributor</option>
<option value="Radio-94">District of Columbia</option>
<option value="Radio-95">Drexel University</option>
<option value="Radio-96">Dubuque</option>
<option value="Radio-97">Duke University</option>
<option value="Radio-98">DuPont</option>
<option value="Radio-99">Duquesne</option>
<option value="Radio-100">East Carolina University</option>
<option value="Radio-101">East Stroudsburg University of Pennsylvania</option>
<option value="Radio-102">Eastern Illinois University</option>
<option value="Radio-103">Eastern Kentucky University</option>
<option value="Radio-104">Eastern Michigan University</option>
<option value="Radio-105">Eastern New Mexico University</option>
<option value="Radio-106">Eastern Oregon University</option>
<option value="Radio-107">Eastern Washington Univ-Spokane</option>
<option value="Radio-108">Eckerd College</option>
<option value="Radio-109">Emory University</option>
<option value="Radio-110">Emporia State University</option>
<option value="Radio-111">Fairfield University</option>
<option value="Radio-112">Fairleigh Dickinson University</option>
<option value="Radio-113">Florida A & M University</option>
<option value="Radio-114">Florida Atlantic University</option>
<option value="Radio-115">Florida Institute of Technology</option>
<option value="Radio-116">Florida International University</option>
<option value="Radio-117">Florida State University</option>
<option value="Radio-118">Food and Drug Administration</option>
<option value="Radio-119">Ford Motor Company</option>
<option value="Radio-120">Fordham University</option>
<option value="Radio-121">Fort Hays</option>
<option value="Radio-122">Four Corners</option>
<option value="Radio-123">Franklin And Marshall College</option>
<option value="Radio-124">Frederick</option>
<option value="Radio-125">General Motors R&D Center</option>
<option value="Radio-126">George Mason University</option>
<option value="Radio-127">George Washington University</option>
<option value="Radio-128">Georgetown University</option>
<option value="Radio-129">Georgia Institute of Technology</option>
<option value="Radio-130">Georgia Southern University</option>
<option value="Radio-131">Grand Valley State University</option>
<option value="Radio-132">Greater Des Moines</option>
<option value="Radio-133">Greater New Orleans</option>
<option value="Radio-134">Greenbrier Valley</option>
<option value="Radio-135">Greensboro</option>
<option value="Radio-136">Grove City College</option>
<option value="Radio-137">GTE Laboratories</option>
<option value="Radio-138">Guelph</option>
<option value="Radio-139">Gulf Coast</option>
<option value="Radio-140">Gustavus Adolphus College</option>
<option value="Radio-141">Hamilton College</option>
<option value="Radio-142">Hampden Sydney/Longwood University</option>
<option value="Radio-143">Hartford</option>
<option value="Radio-144">Harvard</option>
<option value="Radio-145">Hollins University</option>
<option value="Radio-146">Honorary Members</option>
<option value="Radio-147">Hope College</option>
<option value="Radio-148">Howard University</option>
<option value="Radio-149">Hughes Laboratories</option>
<option value="Radio-150">Humboldt State University</option>
<option value="Radio-151">Hungarian</option>
<option value="Radio-152">Hunter College</option>
<option value="Radio-153">Iberian</option>
<option value="Radio-154">Idaho State University</option>
<option value="Radio-155">Illinois Institute of Technology</option>
<option value="Radio-156">Illinois State Univ./Illinois Wesleyan Univ.</option>
<option value="Radio-157">Indiana University</option>
<option value="Radio-158">Indiana University Medical Center</option>
<option value="Radio-159">Indiana University of Pennsylvania</option>
<option value="Radio-160">Indiana University-Purdue Univ. at Ft. Wayne</option>
<option value="Radio-161">Iowa State University</option>
<option value="Radio-162">Ithaca College</option>
<option value="Radio-163">Jacksonville</option>
<option value="Radio-164">John Deere</option>
<option value="Radio-165">Johns Hopkins University</option>
<option value="Radio-166">Johnson & Johnson</option>
<option value="Radio-167">Kalamazoo, Michigan</option>
<option value="Radio-168">Kansas City</option>
<option value="Radio-169">Kansas State University</option>
<option value="Radio-170">Kennesaw State University</option>
<option value="Radio-171">Kent State University</option>
<option value="Radio-172">Kirksville</option>
<option value="Radio-173">Knox College</option>
<option value="Radio-174">Lafayette College</option>
<option value="Radio-175">Lake Forest College</option>
<option value="Radio-176">Lamar University</option>
<option value="Radio-177">Lawrence Livermore National Lab</option>
<option value="Radio-178">Lehigh University</option>
<option value="Radio-179">Lehman College</option>
<option value="Radio-180">Loma Linda University</option>
<option value="Radio-181">Louisiana State University</option>
<option value="Radio-182">Louisiana Tech University</option>
<option value="Radio-183">Louisville</option>
<option value="Radio-184">Loyola Marymount University</option>
<option value="Radio-185">Loyola University</option>
<option value="Radio-186">Lynchburg</option>
<option value="Radio-187">M.W. Kellogg</option>
<option value="Radio-188">Magic Valley</option>
<option value="Radio-189">Manhattan College</option>
<option value="Radio-190">Manitoba</option>
<option value="Radio-191">Marquette University</option>
<option value="Radio-192">Marshall University</option>
<option value="Radio-193">Massachusetts Institute of Technology</option>
<option value="Radio-194">Mayo Foundation</option>
<option value="Radio-195">McDaniel College</option>
<option value="Radio-196">McMaster University</option>
<option value="Radio-197">Membership At Large</option>
<option value="Radio-198">Mercer University</option>
<option value="Radio-199">Merrimack College</option>
<option value="Radio-200">Mesa State College</option>
<option value="Radio-201">Miami University-Ohio</option>
<option value="Radio-202">Michigan State University</option>
<option value="Radio-203">Michigan Technological University</option>
<option value="Radio-204">Middle Tennessee State University</option>
<option value="Radio-205">Midwestern University</option>
<option value="Radio-206">Minnesota State University, Mankato</option>
<option value="Radio-207">Minot State University</option>
<option value="Radio-208">Mississippi State University</option>
<option value="Radio-209">Missouri University of Science and Technology</option>
<option value="Radio-210">Montana State University</option>
<option value="Radio-211">Montana Tech University of Montana</option>
<option value="Radio-212">Montclair State University</option>
<option value="Radio-213">Monterrey Institute for Technology & Education</option>
<option value="Radio-214">Mount Holyoke College</option>
<option value="Radio-215">Mount Sinai School of Medicine</option>
<option value="Radio-216">Murray State University</option>
<option value="Radio-217">Muskingum College</option>
<option value="Radio-218">Nalco Chemical</option>
<option value="Radio-219">Natick</option>
<option value="Radio-220">National Institute of Standards and Technology</option>
<option value="Radio-221">Naval Air Warfare Center Training Systems</option>
<option value="Radio-222">Naval Postgraduate School</option>
<option value="Radio-223">Naval Research Laboratory-Edison</option>
<option value="Radio-224">New Jersey Institute of Technology</option>
<option value="Radio-225">New Mexico Highlands University</option>
<option value="Radio-226">New Mexico Institute of Mining and Tech</option>
<option value="Radio-227">New Mexico State University</option>
<option value="Radio-228">New York University</option>
<option value="Radio-229">New York University College of Dentistry</option>
<option value="Radio-230">New Zealand</option>
<option value="Radio-231">Newark</option>
<option value="Radio-232">Nordic</option>
<option value="Radio-233">North Carolina Central University</option>
<option value="Radio-234">North Carolina State University</option>
<option value="Radio-235">North Dakota State University</option>
<option value="Radio-236">North Shore</option>
<option value="Radio-237">Northeastern Oklahoma State University</option>
<option value="Radio-238">Northeastern University</option>
<option value="Radio-239">Northern Arizona</option>
<option value="Radio-240">Northern Illinois University</option>
<option value="Radio-241">Northern Kentucky University</option>
<option value="Radio-242">Northern Michigan University</option>
<option value="Radio-243">Northern Westchester</option>
<option value="Radio-244">Northwest Indiana</option>
<option value="Radio-245">Northwestern Pennsylvania</option>
<option value="Radio-246">Northwestern State University of Louisiana</option>
<option value="Radio-247">Northwestern University</option>
<option value="Radio-248">Nova Southeastern University</option>
<option value="Radio-249">Oak Ridge</option>
<option value="Radio-250">Oakland University</option>
<option value="Radio-251">Oberlin College</option>
<option value="Radio-252">Ohio Northern University</option>
<option value="Radio-253">Ohio State University</option>
<option value="Radio-254">Ohio University</option>
<option value="Radio-255">Ohio Wesleyan University</option>
<option value="Radio-256">Oklahoma State University</option>
<option value="Radio-257">Olin</option>
<option value="Radio-258">Omaha</option>
<option value="Radio-259">Oneonta</option>
<option value="Radio-260">Orange County</option>
<option value="Radio-261">Oregon State University</option>
<option value="Radio-262">Ottawa</option>
<option value="Radio-263">Pace University</option>
<option value="Radio-264">Panama City</option>
<option value="Radio-265">Pennsylvania State University</option>
<option value="Radio-266">Peoria</option>
<option value="Radio-267">Philadelphia College of Osteopathic Medicine</option>
<option value="Radio-268">Picatinny</option>
<option value="Radio-269">Pikes Peak</option>
<option value="Radio-270">Polytechnic/SUNY Old Westbury</option>
<option value="Radio-271">Prague Institute of Advanced Studies</option>
<option value="Radio-272">Prairie View A & M University</option>
<option value="Radio-273">Princeton</option>
<option value="Radio-274">Providence College</option>
<option value="Radio-275">Purdue University</option>
<option value="Radio-276">Purdue University Calumet</option>
<option value="Radio-277">Queens College</option>
<option value="Radio-278">Quinnipiac</option>
<option value="Radio-279">Radford University</option>
<option value="Radio-280">Ramapo College of New Jersey</option>
<option value="Radio-281">Regis College</option>
<option value="Radio-282">Rensselaer Polytechnic Institute</option>
<option value="Radio-283">Research Triangle Park</option>
<option value="Radio-284">Rhode Island College</option>
<option value="Radio-285">Rice University-Texas Medical Center</option>
<option value="Radio-286">Rider University</option>
<option value="Radio-287">Roanoke College</option>
<option value="Radio-288">Roche Research</option>
<option value="Radio-289">Rockefeller University</option>
<option value="Radio-290">Rockford University</option>
<option value="Radio-291">Rollins College</option>
<option value="Radio-292">Rosalind Franklin University</option>
<option value="Radio-293">Rush University</option>
<option value="Radio-294">Rutgers, The State University of New Jersey</option>
<option value="Radio-295">Saint Bonaventure University</option>
<option value="Radio-296">Saint Cloud State University</option>
<option value="Radio-297">Saint Joseph's University</option>
<option value="Radio-298">Saint Louis University</option>
<option value="Radio-299">Saint Mary's College of California</option>
<option value="Radio-300">Sam Houston State University</option>
<option value="Radio-301">San Diego</option>
<option value="Radio-302">San Francisco State University</option>
<option value="Radio-303">San Joaquin Valley</option>
<option value="Radio-304">San Jose State University</option>
<option value="Radio-305">Sangamon State University</option>
<option value="Radio-306">Santa Clara University</option>
<option value="Radio-307">Savannah</option>
<option value="Radio-308">Seton Hall University</option>
<option value="Radio-309">Shenandoah Valley</option>
<option value="Radio-310">Shreveport</option>
<option value="Radio-311">Sigma Xi McGill</option>
<option value="Radio-312">Slippery Rock University</option>
<option value="Radio-313">Smith College</option>
<option value="Radio-314">Sonoma State University</option>
<option value="Radio-315">South Dakota State University</option>
<option value="Radio-316">South Florida Water Management District</option>
<option value="Radio-317">South Texas</option>
<option value="Radio-318">Southcentral Pennsylvania</option>
<option value="Radio-319">Southeast Missouri State University</option>
<option value="Radio-320">Southern Appalachian</option>
<option value="Radio-321">Southern Illinois University-Carbondale</option>
<option value="Radio-322">Southern Illinois University-Edwardsville</option>
<option value="Radio-323">Southern Indiana</option>
<option value="Radio-324">Southern Maine</option>
<option value="Radio-325">Southern Methodist University</option>
<option value="Radio-326">Southern Oregon</option>
<option value="Radio-327">Southern University</option>
<option value="Radio-328">Southwest Missouri State University</option>
<option value="Radio-329">Stanford University</option>
<option value="Radio-330">State University College at Brockport</option>
<option value="Radio-331">State University College at Buffalo</option>
<option value="Radio-332">State University College at Fredonia</option>
<option value="Radio-333">State University College at New Paltz</option>
<option value="Radio-334">State University College at Plattsburgh</option>
<option value="Radio-335">State University of New York at Oswego</option>
<option value="Radio-336">State University of West Georgia</option>
<option value="Radio-337">Stephen F. Austin State Univ</option>
<option value="Radio-338">Stevens Institute of Technology</option>
<option value="Radio-339">SUNY at Buffalo</option>
<option value="Radio-340">SUNY at Cortland</option>
<option value="Radio-341">SUNY at Purchase</option>
<option value="Radio-342">SUNY at Stony Brook</option>
<option value="Radio-343">SUNY Health Science Center at Brooklyn</option>
<option value="Radio-344">Swarthmore College</option>
<option value="Radio-345">Swiss</option>
<option value="Radio-346">Syracuse</option>
<option value="Radio-347">Tahoma</option>
<option value="Radio-348">Tampa Bay</option>
<option value="Radio-349">Tarleton State University</option>
<option value="Radio-350">Temple University</option>
<option value="Radio-351">Tennessee A & I Fisk-Meharry</option>
<option value="Radio-352">Tennessee Technological University</option>
<option value="Radio-353">Texas A & M - Commerce</option>
<option value="Radio-354">Texas A & M University</option>
<option value="Radio-355">Texas Christian University</option>
<option value="Radio-356">Texas Tech University</option>
<option value="Radio-357">Texas Woman's University</option>
<option value="Radio-358">The University of Findlay</option>
<option value="Radio-359">The University of Louisiana at Lafayette</option>
<option value="Radio-360">The University of Louisiana at Monroe</option>
<option value="Radio-361">Thomas Jefferson University</option>
<option value="Radio-362">Tidewater Virginia</option>
<option value="Radio-363">Tifton</option>
<option value="Radio-364">Towson</option>
<option value="Radio-365">Tri-Cities Washington</option>
<option value="Radio-366">Tri-State University</option>
<option value="Radio-367">Triple Cities New York</option>
<option value="Radio-368">Tufts University</option>
<option value="Radio-369">Tulsa</option>
<option value="Radio-370">Tuskegee University</option>
<option value="Radio-371">U.S. Naval Academy</option>
<option value="Radio-372">UNAM</option>
<option value="Radio-373">Union College</option>
<option value="Radio-374">Univ. of North Carolina-Wilmington</option>
<option value="Radio-375">Univ. of Oklahoma Health Science Center</option>
<option value="Radio-376">Univ. of Texas Southwestern Medical Center</option>
<option value="Radio-377">University of Akron</option>
<option value="Radio-378">University of Alabama</option>
<option value="Radio-379">University of Alabama in Huntsville</option>
<option value="Radio-380">University of Alabama-Birmingham</option>
<option value="Radio-381">University of Alberta</option>
<option value="Radio-382">University of Arizona</option>
<option value="Radio-383">University of Arkansas-Fayetteville</option>
<option value="Radio-384">University of Bridgeport</option>
<option value="Radio-385">University of British Columbia</option>
<option value="Radio-386">University of Calgary</option>
<option value="Radio-387">University of California, Merced</option>
<option value="Radio-388">University of California-Berkeley</option>
<option value="Radio-389">University of California-Davis</option>
<option value="Radio-390">University of California-Irvine</option>
<option value="Radio-391">University of California-Los Angeles</option>
<option value="Radio-392">University of California-Riverside</option>
<option value="Radio-393">University of California-Santa Barbara</option>
<option value="Radio-394">University of California-Santa Cruz</option>
<option value="Radio-395">University of Central Florida</option>
<option value="Radio-396">University of Central Missouri</option>
<option value="Radio-397">University of Central Oklahoma</option>
<option value="Radio-398">University of Chicago</option>
<option value="Radio-399">University of Cincinnati</option>
<option value="Radio-400">University of Colorado</option>
<option value="Radio-401">University of Connecticut</option>
<option value="Radio-402">University of Connecticut Health Center</option>
<option value="Radio-403">University of Dayton</option>
<option value="Radio-404">University of Delaware</option>
<option value="Radio-405">University of Denver</option>
<option value="Radio-406">University of Florida</option>
<option value="Radio-407">University of Georgia</option>
<option value="Radio-408">University of Hartford</option>
<option value="Radio-409">University of Hawaii</option>
<option value="Radio-410">University of Hawaii-Hilo</option>
<option value="Radio-411">University of Houston</option>
<option value="Radio-412">University of Idaho</option>
<option value="Radio-413">University of Illinois</option>
<option value="Radio-414">University of Illinois at Chicago</option>
<option value="Radio-415">University of Iowa</option>
<option value="Radio-416">University of Kansas</option>
<option value="Radio-417">University of Kansas Medical Center</option>
<option value="Radio-418">University of Kentucky</option>
<option value="Radio-419">University of Maine</option>
<option value="Radio-420">University of Maryland</option>
<option value="Radio-421">University of Massachusetts</option>
<option value="Radio-422">University of Massachusetts-Dartmouth</option>
<option value="Radio-423">University of Massachusetts-Lowell</option>
<option value="Radio-424">University of Memphis</option>
<option value="Radio-425">University of Miami</option>
<option value="Radio-426">University of Michigan</option>
<option value="Radio-427">University of Minnesota</option>
<option value="Radio-428">University of Minnesota at Duluth</option>
<option value="Radio-429">University of Mississippi</option>
<option value="Radio-430">University of Mississippi Medical Center</option>
<option value="Radio-431">University of Missouri</option>
<option value="Radio-432">University of Missouri-St. Louis</option>
<option value="Radio-433">University of Montana</option>
<option value="Radio-434">University of Nebraska</option>
<option value="Radio-435">University of Nebraska at Kearney</option>
<option value="Radio-436">University of Nevada</option>
<option value="Radio-437">University of Nevada-Las Vegas</option>
<option value="Radio-438">University of New Hampshire</option>
<option value="Radio-439">University of New Mexico</option>
<option value="Radio-440">University of North Carolina-Asheville</option>
<option value="Radio-441">University of North Carolina-Chapel Hill</option>
<option value="Radio-442">University of North Dakota</option>
<option value="Radio-443">University of North Texas</option>
<option value="Radio-444">University of Northern Colorado</option>
<option value="Radio-445">University of Northern Iowa</option>
<option value="Radio-446">University of Notre Dame</option>
<option value="Radio-447">University of Oklahoma</option>
<option value="Radio-448">University of Oregon</option>
<option value="Radio-449">University of Pennsylvania</option>
<option value="Radio-450">University of Pittsburgh</option>
<option value="Radio-451">University of Puerto Rico at Mayaguez</option>
<option value="Radio-452">University of Puerto Rico at San Juan</option>
<option value="Radio-453">University of Rhode Island</option>
<option value="Radio-454">University of Richmond</option>
<option value="Radio-455">University of Rochester</option>
<option value="Radio-456">University of Scranton</option>
<option value="Radio-457">University of South Alabama</option>
<option value="Radio-458">University of South Carolina</option>
<option value="Radio-459">University of South Dakota</option>
<option value="Radio-460">University of Southern California</option>
<option value="Radio-461">University of Southern Mississippi</option>
<option value="Radio-462">University of Tennessee</option>
<option value="Radio-463">University of Tennessee at Chattanooga</option>
<option value="Radio-464">University of Tennessee at Martin</option>
<option value="Radio-465">University of Tennessee Memphis</option>
<option value="Radio-466">University of Texas at Arlington</option>
<option value="Radio-467">University of Texas at Austin</option>
<option value="Radio-468">University of Texas at Brownsville</option>
<option value="Radio-469">University of Texas at Dallas</option>
<option value="Radio-470">University of Texas at El Paso</option>
<option value="Radio-471">University of Texas Medical Branch</option>
<option value="Radio-472">University of the Sciences in Philadelphia</option>
<option value="Radio-473">University of The South</option>
<option value="Radio-474">University of Toledo</option>
<option value="Radio-475">University of Toronto</option>
<option value="Radio-476">University of Utah</option>
<option value="Radio-477">University of Virginia</option>
<option value="Radio-478">University of Washington</option>
<option value="Radio-479">University of Wisconsin</option>
<option value="Radio-480">University of Wisconsin-Eau Claire/Stout</option>
<option value="Radio-481">University of Wisconsin-Green Bay</option>
<option value="Radio-482">University of Wisconsin-La Crosse</option>
<option value="Radio-483">University of Wisconsin-Milwaukee</option>
<option value="Radio-484">University of Wisconsin-Oshkosh</option>
<option value="Radio-485">University of Wisconsin-Stevens Point</option>
<option value="Radio-486">Ursinus College</option>
<option value="Radio-487">Utah State University</option>
<option value="Radio-488">Vanderbilt University</option>
<option value="Radio-489">Vassar College</option>
<option value="Radio-490">Ventura County</option>
<option value="Radio-491">Vermont</option>
<option value="Radio-492">Villanova University</option>
<option value="Radio-493">Virginia Commonwealth University</option>
<option value="Radio-494">Virginia Polytechnic Institute and State University</option>
<option value="Radio-495">Virginia State University</option>
<option value="Radio-496">Wabash Valley</option>
<option value="Radio-497">Wake Forest University</option>
<option value="Radio-498">Washington College</option>
<option value="Radio-499">Washington State University</option>
<option value="Radio-500">Washington State University Vancouver</option>
<option value="Radio-501">Washington University</option>
<option value="Radio-502">Waterways Experiment Station</option>
<option value="Radio-503">Wayne State University</option>
<option value="Radio-504">Weber State University</option>
<option value="Radio-505">Wellesley College</option>
<option value="Radio-506">Wesleyan University</option>
<option value="Radio-507">West Chester University</option>
<option value="Radio-508">West Virginia University</option>
<option value="Radio-509">Westchester</option>
<option value="Radio-510">Western Carolina University</option>
<option value="Radio-511">Western Connecticut State University</option>
<option value="Radio-512">Western Illinois University</option>
<option value="Radio-513">Western Kentucky University</option>
<option value="Radio-514">Western Pennsylvania</option>
<option value="Radio-515">Western Washington University</option>
<option value="Radio-516">Whitman College-Walla Walla University</option>
<option value="Radio-517">Whitworth University</option>
<option value="Radio-518">Wichita State University</option>
<option value="Radio-519">Wilkes University</option>
<option value="Radio-520">William Paterson University</option>
<option value="Radio-521">Williams College</option>
<option value="Radio-522">Wittenberg University</option>
<option value="Radio-523">Woods Hole</option>
<option value="Radio-524">Wooster Ohio</option>
<option value="Radio-525">Worcester Polytechnic Institute</option>
<option value="Radio-526">Wright State University</option>
<option value="Radio-527">Wyoming</option>
<option value="Radio-528">Yale University</option>
<option value="Radio-529">York College of CUNY</option>
<option value="Radio-530">Youngstown State University</option>
</select>
</div>
<div class="clear"></div>
<div id="q11" class="q full_width">
<a class="item_anchor" name="ItemAnchor55"></a>
<div class="segment_header" style="background:#0C2D83;width:auto;text-align:Left;">
<h1 style="font-size:20px;font-family:'Sanchez',serif;padding-bottom:20px;padding-top:20px;">Dues & Fees</h1>
</div>
</div>
<div class="clear"></div>
<div id="q117" class="q required">
<a class="item_anchor" name="ItemAnchor80"></a>
<span class="question top_question"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Select one of the dues options listed below:</span> <b class="icon_required" style="color:#F00">*</b></span>
<table class="inline_grid choices">
<tbody>
<tr>
<td><input type="radio" name="RESULT_RadioButton-80" class="multiple_choice" id="RESULT_RadioButton-80_0" value="Radio-0"><label for="RESULT_RadioButton-80_0"><span
style="font-size:16px;"><b>Regular Member - 1 Year: US $125.00</b> (Expires on June 30, 2024)</span></label></td>
</tr>
<tr>
<td><input type="radio" name="RESULT_RadioButton-80" class="multiple_choice" id="RESULT_RadioButton-80_1" value="Radio-1"><label for="RESULT_RadioButton-80_1"><span
style="font-size:16px;"><b>Regular Member - 2 Years: US $250.00</b> (Expires on June 30, 2025)</span></label></td>
</tr>
<tr>
<td><input type="radio" name="RESULT_RadioButton-80" class="multiple_choice" id="RESULT_RadioButton-80_2" value="Radio-2"><label for="RESULT_RadioButton-80_2"><span
style="font-size:16px;"><b>Regular Member - 3 Years: US $375.00</b> (Expires on June 30, 2026)</span></label></td>
</tr>
<tr>
<td><input type="radio" name="RESULT_RadioButton-80" class="multiple_choice" id="RESULT_RadioButton-80_3" value="Radio-3"><label for="RESULT_RadioButton-80_3"><span
style="font-size:16px;"><b>Regular Member - 4 Years: US $500.00</b> (Expires on June 30, 2027)</span></label></td>
</tr>
<tr>
<td><input type="radio" name="RESULT_RadioButton-80" class="multiple_choice" id="RESULT_RadioButton-80_4" value="Radio-4"><label for="RESULT_RadioButton-80_4"><span
style="font-size:16px;"><b>Regular Member - 5 Years: US $625.00</b> (Expires on June 30, 2028)<br><br></span></label></td>
</tr>
<tr>
<td><input type="radio" name="RESULT_RadioButton-80" class="multiple_choice" id="RESULT_RadioButton-80_5" value="Radio-5"><label for="RESULT_RadioButton-80_5"><span
style="font-size:16px;"><b>Transitional/Post Doc - 1 Year: US $55.00</b> (Expires on June 30, 2024) <br> * Available to non-students
for the first 3 years after graduation.<br><br></span></label></td>
</tr>
<tr>
<td><input type="radio" name="RESULT_RadioButton-80" class="multiple_choice" id="RESULT_RadioButton-80_6" value="Radio-6"><label for="RESULT_RadioButton-80_6"><span
style="font-size:16px;"><b>Student - 1 Year: US $40.00</b> (Expires on June 30, 2024)</span></label></td>
</tr>
<tr>
<td><input type="radio" name="RESULT_RadioButton-80" class="multiple_choice" id="RESULT_RadioButton-80_7" value="Radio-7"><label for="RESULT_RadioButton-80_7"><span
style="font-size:16px;"><b>Student - 2 Years: US $80.00</b> (Expires on June 30, 2025)</span></label></td>
</tr>
<tr>
<td><input type="radio" name="RESULT_RadioButton-80" class="multiple_choice" id="RESULT_RadioButton-80_8" value="Radio-8"><label for="RESULT_RadioButton-80_8"><span
style="font-size:16px;"><b>Student - 3 Years: US $120.00</b> (Expires on June 30, 2026)</span></label></td>
</tr>
<tr>
<td><input type="radio" name="RESULT_RadioButton-80" class="multiple_choice" id="RESULT_RadioButton-80_9" value="Radio-9"><label for="RESULT_RadioButton-80_9"><span
style="font-size:16px;"><b>Student - 4 Years: US $160.00</b> (Expires on June 30, 2027)</span></label></td>
</tr>
<tr>
<td><input type="radio" name="RESULT_RadioButton-80" class="multiple_choice" id="RESULT_RadioButton-80_10" value="Radio-10"><label for="RESULT_RadioButton-80_10"><span
style="font-size:16px;"><b>Student - 5 Years: US $200.00 </b> (Expires on June 30, 2028)<br><br></span></label></td>
</tr>
<tr>
<td><input type="radio" name="RESULT_RadioButton-80" class="multiple_choice" id="RESULT_RadioButton-80_11" value="Radio-11"><label for="RESULT_RadioButton-80_11"><span
style="font-size:16px;"><b>Young & International Scientists Fund: US $62.50</b><br> (Expires on June 30, 2024) <br>I wish to take advantage of the Young and International
Scientists Fund. I am gainfully employed full time and earn less than US$20,000 annually. I agree to pay dues at the rate of US$62.50 plus US$20.00 initiation fee. The fund will pay the balance. I understand that I must apply for
this fund each year I wish to use it.</span></label></td>
</tr>
</tbody>
</table>
</div>
<div class="clear"></div>
<div id="q119" class="q required display_hidden">
<a class="item_anchor" name="ItemAnchor81"></a>
<span class="question top_question"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Select one of the dues options listed below:</span> <b class="icon_required" style="color:#F00">*</b></span>
<table class="inline_grid choices">
<tbody>
<tr>
<td><input type="radio" name="RESULT_RadioButton-81" class="multiple_choice" id="RESULT_RadioButton-81_0" value="Radio-0" disabled=""><label for="RESULT_RadioButton-81_0"><span
style="font-size:16px;"><b>Regular Member - 1 Year</b> (Expires on June 30, 2024)</span><br><br></label></td>
</tr>
<tr>
<td><input type="radio" name="RESULT_RadioButton-81" class="multiple_choice" id="RESULT_RadioButton-81_1" value="Radio-1" disabled=""><label for="RESULT_RadioButton-81_1"><span
style="font-size:16px;"><b>Transitional/Post Doc - 1 Year</b> (Expires on June 30, 2024) <br> * Available to non-students for the first 3 years after
graduation.<br><br></span></label></td>
</tr>
<tr>
<td><input type="radio" name="RESULT_RadioButton-81" class="multiple_choice" id="RESULT_RadioButton-81_2" value="Radio-2" disabled=""><label for="RESULT_RadioButton-81_2"><span
style="font-size:16px;"><b>Student - 1 Year</b> (Expires on June 30, 2024)</span></label></td>
</tr>
</tbody>
</table>
</div>
<div class="clear"></div>
<div id="q73" class="q required">
<a class="item_anchor" name="ItemAnchor82"></a>
<span class="question top_question"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Fees:</span> <b class="icon_required" style="color:#F00">*</b></span>
<table class="inline_grid choices">
<tbody>
<tr>
<td><input type="radio" name="RESULT_RadioButton-82" class="multiple_choice" id="RESULT_RadioButton-82_0" value="Radio-0" checked=""><label for="RESULT_RadioButton-82_0"><span
style="font-size:16px;"><b>Initiation Fee: US $20.00</b></span></label></td>
</tr>
</tbody>
</table>
</div>
<div class="clear"></div>
<div id="q120" class="q display_hidden">
<a class="item_anchor" name="ItemAnchor83"></a>
<span class="question top_question"><span style="font-size: 16px; font-family: Tahoma, sans-serif;">Automatic Annual Dues Payment Program:</span></span>
<table class="inline_grid choices">
<tbody>
<tr>
<td><input type="checkbox" name="RESULT_CheckBox-83" class="multiple_choice" id="RESULT_CheckBox-83_0" value="CheckBox-0" checked="" disabled=""><label for="RESULT_CheckBox-83_0"><span style="font-size:16px;"> Enroll in
Automatic Dues Payment:</span></label></td>
</tr>
</tbody>
</table>
</div>
<div class="clear"></div>
<div id="q115" class="q full_width display_hidden">
<a class="item_anchor" name="ItemAnchor84"></a>
<div class="full_width_space">
<div><span style="font-size: 16px; font-family: 'Open Sans', sans-serif;">For your convenience, Sigma Xi will automatically charge your credit/debit card in May of each year for annual membership dues. This amount will also include your local
chapter dues, if your chapter has local dues, as well as an additional $20.00 if you have chosen to receive both print and digital editions of <em>American Scientist</em> magazine. If you wish to make changes to your account at any time
please notify Sigma Xi at <a href="mailto:membership@sigmaxi.org">membership@sigmaxi.org</a> at least 15 days in advance of May 1st. By submitting this form, you are confirming your status as an authorized user of this credit/debit
card.</span></div>
</div>
</div>
<div class="clear"></div>
<div id="q16" class="q">
<a class="item_anchor" name="ItemAnchor85"></a>
<span class="question top_question"><span style="font-size: 16px; font-family: Tahoma, sans-serif;"><br><span style="font-size: 18px;">Total Dues & Fees:</span></span></span>
<div class="calculation"><span>$0.00</span><button type="button" class="calculation_button">Calculate</button></div>
</div>
<div class="clear"></div>
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subject_line NOMINATION ACCEPTANCE FORM Please choose one. Membership grade is listed in your nomination email. * Yes, I accept the nomination to Full Membership in Sigma Xi. Yes, I accept the nomination to Associate Membership in Sigma Xi. Are you currently a degree seeking student? * Yes No Prefix: * Dr. Mr. Ms. Mrs. Mx. First Name: * M.I. Last Name: * Suffix: Preferred Phone #: * Preferred Email: * Alternate Email: Date of Birth (mm/dd/yyyy): * MAILING ADDRESS (THIS IS WHERE YOUR MEMBERSHIP CERTIFICATE WILL BE MAILED.) 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Engineering ENGR - 309 Engineering, General ENGR - 310 Environmental & Sanitary Engineering ENGR - 311 Industrial Engineering ENGR - 312 Materials Science ENGR - 313 Mechanical Engineering ENGR - 314 Metallurgy ENGR - 315 Mining & Mineral Engineering ENGR - 316 Naval Architecture & Marine Engineering ENGR - 317 Nuclear Engineering ENGR - 319 Textile Engineering ENGR - 320 Petroleum Engineering ENGR - 321 Quality Engineering ENGR - 322 Metallurgical Engineering ENGR - 323 Nondestructive Testing ENGR - 350 Other Engineering Sciences HEALTH - 105 Biometrics/Biostatistics HEALTH - 112 Genetics HEALTH - 120 Pathology HEALTH - 121 Physiology HEALTH - 125 Toxicology HEALTH - 211 Veterinary Medicine HEALTH - 401 Dentistry HEALTH - 402 Dermatology HEALTH - 403 Endocrinology HEALTH - 404 Health Professions, General HEALTH - 405 Hospital & Health Care Administration HEALTH - 406 Medical Laboratory Technology HEALTH - 407 Medical Record Librarianship HEALTH - 408 Medicine HEALTH - 409 Nursing HEALTH - 410 Occupational Therapy HEALTH - 411 Ophthalmology HEALTH - 412 Pediatrics HEALTH - 413 Physical Therapy HEALTH - 414 Psychiatry HEALTH - 415 Public Health/Epidemiology HEALTH - 416 Podiatry HEALTH - 417 Radiology HEALTH - 418 Speech Pathology & Audiology HEALTH - 419 Surgery HEALTH - 420 Obstetrics/Gynecology HEALTH - 421 Immunology HEALTH - 422 Nutrition HEALTH - 423 Otolaryngology HEALTH - 424 Forensic Science HEALTH - 425 Medicinal Chemistry HEALTH - 450 Other Health Sciences HEALTH - 615 Pharmacology/Pharmacy MA/CS - 308 Electrical, Electronics, & Comm Engineering MA/CS - 501 Applied Mathematics MA/CS - 502 Artificial Intelligence MA/CS - 503 Computer Science, General MA/CS - 504 Mathematics, General MA/CS - 505 Statistics MA/CS - 506 Systems Analysis MA/CS - 507 Number Theory & Combinatorics MA/CS - 508 Algebra & Geometry MA/CS - 509 Differential Equations & Functional Analysis MA/CS - 510 Topology MA/CS - 511 Numerical Analysis MA/CS - 550 Other Math & Computer Sciences PHYS - 213 Hydrology PHYS - 312 Materials Science PHYS - 601 Astronomy PHYS - 602 Astrophysics PHYS - 603 Atmospheric Sciences & Meteorology PHYS - 604 Chemistry PHYS - 605 Geochemistry PHYS - 606 Geology PHYS - 607 Geophysics PHYS - 608 Inorganic Chemistry PHYS - 609 Mineralogy PHYS - 610 Molecular Physics PHYS - 611 Nuclear Physics PHYS - 612 Oceanography PHYS - 613 Organic Chemistry PHYS - 614 Paleontology PHYS - 615 Pharmacology/Pharmacy PHYS - 616 Physical Chemistry PHYS - 617 Physical Geography PHYS - 618 Physics, General (Exclude Biophysics) PHYS - 619 Analytical Chemistry PHYS - 620 Atomic Physics PHYS - 621 Condensed Matter PHYS - 622 Elementary Particles PHYS - 623 Plasma Physics PHYS - 624 Optics & Laser Physics PHYS - 625 Crystallography PHYS - 626 Polymer Science PHYS - 627 Nuclear Chemistry PHYS - 628 Particle Physics PHYS - 650 Other Physical & Earth Sciences SOC - 701 Administration (Organization & Management) SOC - 702 Anthropology SOC - 703 Archaeology SOC - 704 Criminology SOC - 705 Demography SOC - 706 Economics SOC - 707 Geography SOC - 708 History SOC - 709 International Relations SOC - 710 Library Science SOC - 711 Linguistics SOC - 712 Philosophy SOC - 713 Political Science & Government SOC - 714 Psychology SOC - 715 Sociology SOC - 716 Urban Studies SOC - 717 Science Policy SOC - 718 Cognitive Science SOC - 719 Education SOC - 720 Science Writing SOC - 721 History & Philosophy of Science SOC - 750 Other Social Sciences Business or Institution (If retired, enter 'Retired'): * Institution: * Position: * Administrator Assistant Professor Associate Professor Editor/Journalist Engineer Physician Postdoc Professor Research Scientist Other Position- Other: * Employment Sector: * Academic Government Healthcare Industry Research and Development Other Employment Sector- Other: * Highest Degree: * BS MA MS PhD MD MD/PhD PharmD EdD Other Highest Degree- Other: * Degree Currently Seeking: * BS MA MS PhD MD MD/PhD PharmD EdD Other Degree Currently Seeking- Other: * Chapter Affiliation: (If none, please select 'Membership At Large') * Abbott Laboratories Air Force Dayton Alamo Alaska Albany Albany, New York Albion College Alcoa Alfred University American University American University of Beirut Amherst College Andrews-Whirlpool Appalachian State University Argonne National Laboratory Arizona State University Arkansas State University Army Research Laboratory (ARL) Atlanta University Center Auburn University Austin College Australian Avalon B. 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of CUNY Youngstown State University DUES & FEES Select one of the dues options listed below: * Regular Member - 1 Year: US $125.00 (Expires on June 30, 2024) Regular Member - 2 Years: US $250.00 (Expires on June 30, 2025) Regular Member - 3 Years: US $375.00 (Expires on June 30, 2026) Regular Member - 4 Years: US $500.00 (Expires on June 30, 2027) Regular Member - 5 Years: US $625.00 (Expires on June 30, 2028) Transitional/Post Doc - 1 Year: US $55.00 (Expires on June 30, 2024) * Available to non-students for the first 3 years after graduation. Student - 1 Year: US $40.00 (Expires on June 30, 2024) Student - 2 Years: US $80.00 (Expires on June 30, 2025) Student - 3 Years: US $120.00 (Expires on June 30, 2026) Student - 4 Years: US $160.00 (Expires on June 30, 2027) Student - 5 Years: US $200.00 (Expires on June 30, 2028) Young & International Scientists Fund: US $62.50 (Expires on June 30, 2024) I wish to take advantage of the Young and International Scientists Fund. I am gainfully employed full time and earn less than US$20,000 annually. I agree to pay dues at the rate of US$62.50 plus US$20.00 initiation fee. The fund will pay the balance. I understand that I must apply for this fund each year I wish to use it. Select one of the dues options listed below: * Regular Member - 1 Year (Expires on June 30, 2024) Transitional/Post Doc - 1 Year (Expires on June 30, 2024) * Available to non-students for the first 3 years after graduation. Student - 1 Year (Expires on June 30, 2024) Fees: * Initiation Fee: US $20.00 Automatic Annual Dues Payment Program: Enroll in Automatic Dues Payment: For your convenience, Sigma Xi will automatically charge your credit/debit card in May of each year for annual membership dues. This amount will also include your local chapter dues, if your chapter has local dues, as well as an additional $20.00 if you have chosen to receive both print and digital editions of American Scientist magazine. If you wish to make changes to your account at any time please notify Sigma Xi at membership@sigmaxi.org at least 15 days in advance of May 1st. By submitting this form, you are confirming your status as an authorized user of this credit/debit card. Total Dues & Fees: $0.00Calculate